Renal Transplant Surgery Research Articles

365.12: Nalbuphine postoperative analgesia for pediatric renal transplantation surgery. A case series report.

365.12: Nalbuphine postoperative analgesia for pediatric renal transplantation surgery. A case series report.

A novel and promising regional anesthesia technique in living-donor renal transplantation surgery: Quadro-iliac plane block.

A novel and promising regional anesthesia technique in living-donor renal transplantation surgery: Quadro-iliac plane block.

Effect of urinary tract infection on the outcome of the allograft in patients with kidney transplantation.

Urinary tract infections (UTIs) are the second most common cause of graft dysfunction, accounting for significant morbidity, and are associated with poor graft and patient survival. This study aimed to assess the association between post-renal transplant UTI and graft outcomes. We examined the effect of UTIs on graft outcomes in patients who underwent renal transplantation surgery between January 2010 and December 2022. The study population included 349 renal transplantations, of which 74 experienced 140 UTI events. Based on the number of UTI episodes, patients were categorized into three groups. Of the 349 recipients, 275 (74.4%) had no UTI, 47 (18.8%) had non-recurrent UTIs (NR-UTIs), and 27 (6.8%) had recurrent UTIs (R-UTIs). Kaplan-Meier survival analysis showed that post-KT UTI status was a significant factor in graft survival, death-censored graft survival, and patient survival after a follow up of 5 years (log rank, P < 0.001). R-UTIs were associated with very poor graft survival and patient survival when compared with no UTI after a follow up of 5 years (hazard ratio [HR], 1.506; 95% confidence interval [CI], 1.233-1.840; P < 0.001 & HR, 1.529; 95% CI, 1.227-1.905; P = 0.001). R-UTIs were more likely to be associated with multi-drug resistant Gram-negative organisms (Klebsiella pneumonia or Escherichia coli) with resistance to nitrofurantoin (RR, 2.753; 95% CI, 1.257-6.032; P = 0.01) and carbapenem (RR, 2.064; 95% CI, 0.988-4.314; P = 0.05). Compared to no UTI, R-UTIs were associated to worse graft and patient outcomes after a follow-up of 5 years, whereas NR-UTIs were associated with poor graft and patient outcomes in the long term.

Multiphasic MDCT of Living Renal Donors, Prior to Surgery

Background: Live kidney donor evaluation mandates anatomical and functional assessment of the donor kidney. Multiphasic Multidetector computed tomography (MDCT) with advanced 3‐D techniques provides a detailed description of the vascular, parenchymal, and collecting system. Objectives: To evaluate the clinical application of Multiphasic MDCT in the pre-operative anatomic assessment of prospective donor kidneys. Methods: Multiphasic MDCT was performed in thirty-eight patients as part of a pre-operative assessment. Each study comprised three phases of imaging, including the arterial, venous, and excretory phases. Results: The predominant radiological finding amongst the cases studied was that of the presence of accessory renal arteries in 35% of the patients. Multiphasic MDT was also able to detect renal parenchymal disease in one case. Post-renal anatomical evaluation also identified renal calculi in 12.5% of the total cases. Conclusions: There is considerable scope for multiphasic MDCT in the pre-operative evaluation of donor kidneys, especially as modern-day renal transplant surgery sees a shift towards laparoscopic techniques where intraoperative anatomic evaluation can be restricted. The multiphasic MDCT is useful in pre-renal, renal, and post-renal anatomic evaluation. Advances in Knowledge: Multiphasic MDCT can provide noninvasive, detailed, and fast images to aid the preoperative evaluation of donor kidneys.

Anatomical Variations in Arrangement of Renal Hilar Structures and its Applied Importance: A Cadaveric Cross-sectional Study among North East Population of India

Introduction: The hilum of the kidney leads into a central renal sinus filled with the renal pelvis and renal vessels. The classical arrangement of the structures present is the renal vein, renal artery, and renal pelvis, from anterior to posterior. Previous studies have shown many variations in the arrangement of the structures in the renal hilum; however, there is a lack of literature on this topic in the North-east region of India, where many communities and tribes reside. Aim: To evaluate both the classical and anatomical variations in the arrangement of the renal hilar structures in human cadavers. Materials and Methods: The present study was a cadaveric cross-sectional study conducted in the Department of Anatomy at Assam Medical College, Assam, India, involving 160 specimens from 80 cadavers, both adult and foetal (≥36 weeks), from July 2013 to June 2014. Among these, 15 were adult cadavers and 65 were perinatal cadavers (11 male and 4 female adults; 28 male and 37 female perinates). The relations of the structures, i.e., renal artery, renal vein, and renal pelvis present in the renal hilum, were studied in an anterior-posterior manner after meticulous dissection. Results: In the present study, the majority of specimens exhibited hilar structures arranged in a VAP pattern (67 kidneys, 41.88%), with a higher occurrence on the left-side (37 kidneys, 23.1%) compared to the right-side (30 kidneys, 18.7%). This was followed by a VAPA pattern (28 kidneys, 17.5%). Variations in the arrangement of hilar structures other than the classical arrangement were observed in more than 59% (93 kidneys) of the specimens. It was noted that the anterior and posterior divisions of the renal artery and the anterior and posterior tributaries of the renal vein occupied the pre-hilar and hilar regions rather than the main trunks. Conclusion: It was observed that the arrangement of the structures present in the renal hilum exhibits a wide spectrum of variations. Knowledge of these variations may be beneficial not only for anatomists but also for urologists and radiologists, as it may help prevent or at least minimise the incidence of intraoperative injuries and post-operative complications. Urological procedures such as nephrectomy and renal transplant operations require careful dissection and separate ligation of the renal vessels present in the renal hilum to prevent arteriovenous fistula and massive haemorrhage. Prior knowledge of unusual arrangements of the hilar structures may assist surgeons in avoiding inadequate ligation of vessels and minimising complications.

Successful Endovascular Management of Juxta Internal Iliac Vessel Pseudoaneurysm with Allograft Preservation in Post-Renal Transplant

Vascular complications following renal transplant surgery are extremely uncommon, and pseudoaneurysm is even rarer, with an incidence of 0.3%. The presentation can vary from acute blood loss to chronic dull aching pain, anorexia, etc. Majority of pseudoaneurysms are associated with allograft loss. We present a case of an anastomotic pseudoaneurysm successfully managed with an endovascular approach. A 54-year-old female, post cadaveric renal transplant (end-to-end anastomosis between the renal artery and right internal iliac artery) presented on post-operative day 159 with complaint of fever with chills. On treating conservatively with antibiotics, the fever subsided, only to recur after 5-days. On further investigation, c-reactive protein (CRP) was found to be persistently elevated. Patient’s fever of unknown origin was further investigated with repeat blood culture and fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT). Blood culture was positive for Klebsiella pneumoniae sensitive to colistin and tigecycline and FDG-PET showed a 5 cm aneurysm of the juxta anastomotic segment of the right internal iliac vessels, a possible pseudoaneurysm. After a multidisciplinary discussion, the patient underwent renal angiography, an aneurysm was delineated, and a covered stent was placed which partially excluded the aneurysm. The patient responded well to the intervention. Pseudoaneurysm formation is a rare and potentially life-threatening complication and can present even in the late post-operative period. Endovascular management can be a safe approach in carefully selected cases with allograft preservation being of paramount importance.

The effect of fibrinoid necrosis on the clinical features and outcomes of primary IgA nephropathy

BackgroundTo explore the clinicopathologic features and outcomes of IgAN patients who presented with fibrinoid necrosis (FN) lesions or not and the effect of immunosuppressive (IS) treatment in IgAN patients with FN lesions as well.MethodsThis was a retrospective cohort study with 665 patients diagnosed with primary IgAN from January 2010 to December 2020 in Tianjin Medical University General Hospital and having detailed baseline and follow-up characteristics. Patients were divided into two groups depending on the appearance of FN lesions. Patients with FN lesions were recruited into Group FN1, while patients who were not found FN lesions in their renal biopsy specimens were recruited into Group FN0. Compare the differences between Group FN0 and Group FN1 in baseline clinicopathologic features, treatment solutions and follow-up data as well. To evaluate the impact of different fractions of FN lesions on baseline characteristics and prognosis of IgAN, we subdivided patients in Group FN1 into 3 groups depending on the FN lesions distribution, Mild Group: 0 < FN% < 1/16; Moderate Group: 1/16 < FN% < 1/10; Severe Group: FN% > 1/10. Furthermore, we compared the differences in baseline clinicopathologic features, treatment solutions and follow-up data among these three groups. Kidney endpoint event was defined as patients went into end-stage kidney disease (ESKD), which estimated glomerular filtration rate (eGFR) < 15 ml/min/1.73 m^2, regularly chronic dialysis over 6 months or received renal transplantation surgery. The kidney composite endpoint was defined by a ≥ 30% reduction in eGFR, double Scr increase than on-set, ESKD, chronic dialysis over 6 months or renal transplantation. Compare the survival from a composite endpoint rate in different groups by Kaplan-Meier survival curve. The univariate and multivariate Cox models were used to establish the basic model for renal outcomes in patients with FN lesions.Results(1) A total of 230 patients (34.59%) were found FN lesions in all participants. Patients with FN lesions suffered more severe hematuria than those without. On the hand of pathological characteristic, patients with FN lesions showed higher proportions of M1, E1, C1/C2 and T1/T2 lesions compared with those without FN lesions. (2) The 1-year, 3-year, and 5-year survival of the composite endpoint were lower in the FN1 group than FN0 group. (3) After adjusting for clinicopathological variables, the presence of FN lesions was a significantly independent risk factor for composite endpoint. By using multivariate Cox regression analyses, we also found when the fraction of FN lesions exceeded 10%, the risk of progression into composite endpoint increased 3.927 times.ConclusionFibrinoid necrosis of capillary loops is an independent risk factor of poor renal outcomes. More effective treatment should be considered for those who had FN lesions.

Study of haemodynamic changes during robotic urological surgeries: Comparison of dexmedetomidine and propofol

Background: General anesthesia induces endocrine, immunologic, and metabolic responses. Certain anesthetic drugs affect the hemodynamic variables of the patient by various mechanism. The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters in robotic renal transplant surgery. Methods: This was a prospective comparative study performed in a tertiary care center. After local ethics committee approval and written informed consent, a total of fifty-two patients of ASA physical status 3 of either sex were randomly selected for this study. They were scheduled for elective robotic urological procedures of around three hours under general anaesthesia and divided into two groups (each group containing 26 patients). According to the haemodynamic requirement inj. dexmedetomidine maintainence(0.2 – 0.7mcg/kg/min) infusion and propofol(25 -75 mcg/kg/min) infusion started and maintained respectively. The measurements were taken on the same arm throughout the study at the following times: baseline,after loading dose,after intubation, after 20 min after the pneumoperitoneum, after 60 minutes of the pneumoperitoneum, after infusion stopped, after extubation. Results: Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P &lt; 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P &lt; 0.001). Conclusions: Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.

O038 Positive impact of an ERAS programme on living and deceased donor renal transplant recipients’ recovery during COVID pandemic

Abstract Introduction An ERAS (Enhanced Recovery After Surgery) programme was created to reduce length of stay (LoS) and improve outcomes following renal transplant surgery. This aimed to reduce post-operative hospital-acquired infection, especially COVID-19. Methods The ERAS protocol was finalised following a literature review and MDT discussion. ERAS information, with post-operative exercise advice, was distributed to patients on the renal transplant waitlist. LOS was evaluated, comparing ERAS with pre-ERAS recipients and, to remove pandemic bias, pre-pandemic (December 2019) recipients. Secondary outcomes were opiate use, mobilisation, bowel function and patient-reported outcomes. ERAS protocol compliance was monitored. Data analysis was with student t-test and Chi-2 test in GraphPad Prism. Results Some 35 consecutive recipients completed ERAS protocol (March 2021). Baseline characteristics were comparable between live-donor recipients 9/35 vs 13/35 pre-ERAS and 12/35 pre-COVID. BMI&amp;gt;30 was higher in ERAS group (19vs. 11vs. 8). Median LoS was significantly reduced: ERAS - 5 days, pre-ERAS - 7 days, pre-COVID - 8 days (p=0.01). 51% of ERAS discharges were within 5 days vs. 17% pre-ERAS vs. none pre-COVID (X2 12.59, p&amp;lt;0.001). For overstayers (&amp;gt;5 days), potential preventable reasons were identified. 79.2% of ERAS recipients mobilised on day 1 post-op. ERAS indicated no significant reduced opiate use. Two ERAS recipients were readmitted within 30 days (vs.9/70 pre-ERAS) and one returned to theatre (vs.5/70 pre-ERAS). Conclusion This ERAS programme successfully reduced the LoS by 2 days in comparative population with minimal adverse events. Patient and staff feedback was positive. It's hypothesised that assigning a specialist ERAS nurse will improve compliance.

Impact of newly diagnosed prostate cancer at time of evaluation for renal transplantation.

Systematic screening for prostate cancer is widely recommended in candidates for renal transplant at the time of listing. There are concerns that overdiagnosis of low-risk prostate cancer may result in reducing access to transplant without demonstrated oncological benefits. The objective of the study was to assess the outcome of newly diagnosed prostate cancer in candidates for transplant at the time of listing, and its impact on transplant access and transplant outcomes according to treatment options. This retrospective study was conducted over 10 years in 12 French transplant centers. Patients included were candidates for renal transplant at the time of prostate cancer diagnosis. Demographical and clinical data regarding renal disease, prostate cancer, and transplant surgery were collected. The primary outcome of the study was the interval between prostate cancer diagnosis and active listing according to treatment options. Overall median time from prostate cancer diagnosis to active listing was 25.0 months [16.4-40.2], with statistically significant differences in median time between the radiotherapy and the active surveillance groups (p=.03). Prostate cancer treatment modalities had limited impact on access and outcome of renal transplantation. Active surveillance in low-risk patients does not seem to compromise access to renal transplantation, nor does it impact oncological outcomes.

Does the Use of Mini-Incisions In Renal Transplantation Surgery Affect Postoperative Parameters: Single Center Experience

Kidney transplantation can be performed with different surgical approaches, such as conventional open kidney transplantation (CKT), minimally invasive kidney transplantation (MIKT), laparoscopic kidney transplantation, and robot-assisted kidney transplantation. Conventional open kidney transplantation is usually performed using a Gibson or hockey stick incision, may be associated with higher wound complication rates, and results in worse cosmetic outcomes compared with minimally invasive methods. Minimally invasive kidney transplantation is performed with a smaller skin incision than CKT but may result in limited surgical exposure. This study aimed to compare the surgical results of MIKT and CKT. Fifty-nine patients with a body mass index of 22 kg/m2 and below and with no anatomic variations in computed tomography were included in the study. Thirty-seven patients who underwent CKT were included in group 1, and twenty-two patients who underwent MIKT were included in group 2. Patient data were collected retrospectively. This study was conducted in compliance with The Helsinki Congress and The Declaration of Istanbul. The mean incision length was calculated as 12.7 cm in group 1 and 7.3 cm in group 2 (P < .05). There was no statistically significant difference between the groups in terms of lodge preparation time, vein clamp time, artery clamp time, ureteroneocystostomy time, visual analog scale scores, postoperative creatinine levels, or complication rates (P > .05 for each comparison). Without compromising the goals and primary concerns of transplantation surgery, MIKT can be offered to selected transplant patients with cosmetic concerns.

Renal transplant and hemostasis: early postoperative changes in recipients and donors

BackgroundThe benefit of administering pharmacologic thromboprophylaxis following renal transplantation remains uncertain. ObjectivesTo compare hemostatic parameters before and after renal transplant surgery in both recipients and their donors at predetermined time points. MethodsBlood samples were collected at baseline (T1), immediately after surgery (T2), and at 24 hours after surgery (T3) in both recipients and donors and at 72 (T4) and 120 hours (T5) from recipients only. Assays included in vitro thrombin generation, factor VIII (FVIIIc) activity, von Willebrand factor (VWF) antigen, D-dimer, antithrombin activity, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes, and plasminogen activator inhibitor-1 (PAI-1) antigen. ResultsFifty-two patients (28 recipients and 24 donors) were enrolled. Both donors and recipients had increased FVIIIc, VWF, F1 + 2, D-dimer, and PAI immediately after surgery but reduced antithrombin. Mixed-model analysis showed that the magnitude of change over time (between T1 and T3) for FVIIIc (mean estimated difference [MED], 72; 95% CI, 41-102; P < .0001), VWF (MED, 89; 95% CI, 35-142; P = .001), F1 + 2 (MED, 283; 95% CI, 144-422; P < .0001), thrombin-antithrombin complexes (MED, 3.5; 95% CI, 1.9-5.1; P < .0001), D-dimer (MED, 2.2; 95% CI, 1.0-3.3; P < .0001), PAI-1 (MED, 9.2; 95% CI, 3.4-14.9; P = .002), and time to peak thrombin generation (MED, 1.5; 95% CI, 0.35-2.7; P = .01) was more significant in recipients than in donors. ConclusionPersistence of a hypercoagulable state was more prominent in recipients after 24 hours despite recovery in renal function and initiation of thromboprophylaxis.

MP31-07 FORVEIN TRIAL: EVALUATION OF THE HEMOSTATIC ROLE OF FIBRIN SEALANT ON RENAL VEIN ANASTOMOSIS DURING RENAL TRANSPLANT SURGERY: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP31-07 FORVEIN TRIAL: EVALUATION OF THE HEMOSTATIC ROLE OF FIBRIN SEALANT ON RENAL VEIN ANASTOMOSIS DURING RENAL TRANSPLANT SURGERY: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL Tejas Mistry, Mrinal Pahwa, and Vipin Tyagi Tejas MistryTejas Mistry More articles by this author , Mrinal PahwaMrinal Pahwa More articles by this author , and Vipin TyagiVipin Tyagi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative bleeding is one of the major complications associated with vascular anastomosis in kidney transplant. One of the novel measures for its prevention is the application of fibrin sealant over renal vein anastomotic site after completing the suturing. Till date, there is no study published to evaluate its role for this purpose. Hence, the current study was undertaken to evaluate the hemostatic role of fibrin sealant on renal vein anastomosis during renal transplant surgery. METHODS: This was a prospective randomised study (FORVEIN stands for Fibrin sealant On Renal VEIN anastomosis) done in our institute from April 2017 to March 2022. Approval of the study protocol was obtained from the Institutional review board. Total 307 renal allograft recipients (with age 18 to 60 years) who had undergone live related renal transplant at our center were included in the study as per the inclusion and exclusion criteria. Patients were randomised according to computer generated random numbers into test group in whom fibrin sealant was to be used and control group in whom saline was to be applied. Time to hemostasis was measured from removal of venous clamps to complete hemostasis at the site and was compared between both the groups. Data regarding age, sex, body mass index, number of vessels was recorded for subgroup analysis. Statistical analysis was done using t-test and MedCalc software (Version 20, Ostend, Belgium). RESULTS: Out of 307 cases, fibrin sealant was applied in 129 cases, whereas 178 cases received saline application. There was significant difference between mean time to hemostasis in fibrin sealant group (7.2min) and in control group (10.2min) (p<0.0001). On subgroup analysis, it was found that hemostasis time was significantly lower in fibrin sealant group for multiple vessels, obese and complex cases with multiple factors (p=0.02, p=0.005, p=0.04 respectively). No case of venous thrombosis was observed. CONCLUSIONS: Application of fibrin sealant over renal vein anastomosis during renal transplant surgery is safe and effective for achieving early hemostasis. Larger multi-centric randomised controlled studies would be needed for its generalized extrapolation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e432 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tejas Mistry More articles by this author Mrinal Pahwa More articles by this author Vipin Tyagi More articles by this author Expand All Advertisement PDF downloadLoading ...

Transplantation &amp; Vascular Surgery: Renal Transplantation &amp; Vascular Surgery I (MP31)

You have accessJournal of UrologyCME1 Apr 2023Transplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I (MP31) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Transplantation &amp; Vascular Surgery: Renal Transplantation &amp; Vascular Surgery II (PD31)

You have accessJournal of UrologyCME1 Apr 2023Transplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (PD31) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Immunosuppressive drugs in renal transplantation

A kidney transplant, sometimes known as a renal transplant, is the treatment of choice for kidney failure at end stage renal disease (ESRD). The renal transplant surgery is followed by a lifetime course of immunosuppressive agents, divided into initial induction phase and later maintenance phase. It is seen that the risk of acute rejection is maximum in the initial months after transplantation (induction phase) and then reduces later (maintenance phase). In induction phase there is use of high-intensity immunosuppression immediately after transplantation, when the risk of rejection is maximum and then the dose reduced for long- term therapy. The main challenge in the renal transplantation community is long- term transplant survival. Long-term graft loss is mainly due to acute and chronic graft rejection, and also due to complications of immunosuppressive therapy. Currently, there is triple therapy as conventional immunosuppressive protocol: a calcineurin inhibitor, an antimetabolite agent, and a corticosteroid. The main aim of development of new immunosuppressive agents is not only improvement of short- term outcomes but also to increase the long- term graft survival by less nephrotoxicity, and minimal side-effects.

Pattern of urinary tract and surgical site infection in allograft renal recipient during early postoperative period

A kidney transplant (KT) offers a significant survival benefit and is the only curative treatment for patients with ESRD. Infectious complications are still a leading cause of morbidity and death among transplant patients. This study aimed to assess the organisms and risk factors responsible for urinary tract and surgical site infection in allograft live-related renal transplant recipients during the early post-transplant period. This observational follow-up study was conducted among 20 purposively selected patients who underwent renal allograft transplant surgery from July 2019 to December 2020 in the Department of Urology, BSMMU, Dhaka. Patients with a history of renal transplant recipients or congenital renal anomalies and any urological malignancy were excluded from the study. After kidney transplant, UTI developed in 6 (30%) renal transplant recipients where all were complicated types and occurred between 10 to 14 days postoperatively. UTI was caused by E. coli in 3 (15%) patients, while Klebsiella and Enterococci were causative organisms for 1 (5%) and 2 (10.0%) patients, respectively. SSI developed in 3 (15%) renal transplant recipients where two were superficial, and one was deep. SSI occurred between 5-8 days postoperatively. SSI was caused by S. aureus in 2 (10%) patients and Pseudomonas in 1 (5%) patient. UTI was significantly more in older patients and the patients with a longer duration of catheterization. Older patients and overweight patients had significantly higher rates of SSI. In total, 33% of the recipient during the early hospital stay developed UTIs, all of which were complicated types. SSI developed in 15%, where 2/3rd was superficial and 1/3rd was deep. Older age with a longer duration of catheterization and DJ stent was found to be associated with the occurrence of UTI, while older age and high BMI were related to the event of SSI. BSMMU J 2022; 15(2): 127-131

Anesthetic management of renal transplant surgery in a patient with severe mitral regurgitation and moderate pulmonary hypertension as sequelae of infective endocarditis

Anesthetic management of renal transplant surgery in a patient with severe mitral regurgitation and moderate pulmonary hypertension as sequelae of infective endocarditis

Peri-hilar branching pattern and variations of the renal artery among Indian kidney donors using pre-operative computed tomography angiography: an anatomical study and review.

The peri-hilar branching pattern of renal arteries and variations such as accessory renal artery and early branching of the renal artery are important factors to be evaluated preoperatively to minimise potential complications during renal transplantation and renal surgeries. The present study was done to assess the peri hilar branching pattern of the renal artery and its variation among the renal donors in India. One hundred ninety eight kidneys from 99 donors were analysed using pre-operative computed tomography renal angiograms prospectively, over 1 year 2 months. Based on the branching pattern of primary and secondary branches of renal arteries, we identified 8 cardinal and 10 minor peri-hilar branching patterns. Type I (duplicated fork) peri-hilar branching pattern was the most frequently found (70.2%) among 198 kidneys, followed by type II (triplicated fork) (19.2%) and type III (ladder) (10.6%). Duplicated fork pattern was common in both the right renal artery (75.7%) and left renal artery (64.6%), respectively. The prevalence of accessory renal artery was 39.4% with hilar artery at 21.2% and polar artery at 18.2%, and the prevalence of early division of renal artery was 20.2%. No significant association was found between gender and laterality in the prevalence of both early division and accessory renal artery (p > 0.05). Early division of renal artery was more frequent in females (28%) whilst accessory renal arteries were more common in males (40.7%). The present study showed a consistent peri-hilar branching pattern with high individual variability among Indian renal donors. The knowledge about the peri-hilar branching pattern as well as renal artery variations conferred by this study would greatly compliment urological surgeons during renal transplant surgeries.

A case of severe bone-marrow suppression due to azathioprine in a patient of kidney transplant

Azathioprine is one of the triple therapy immunosuppressive agents used in patients of renal transplant. Azathioprine is being used successfully in majority of patients of renal graft. But one of the dreaded complications caused by it is severe bone-marrow suppression. Here I am reporting a case of severe, life- threatening bone-marrow suppression in a 30 years old male patient of renal transplant. The case is very important and attention is needed to be given by health care professionals and by clinicians. The patient underwent renal transplant surgery in Indraprastha Apollo hospital, New Delhi. The patient was on immunosuppressive agents: prednisolone, cyclosporine and mycophenolate mofetil. After 10 months of renal transplant surgery, the patient was switched over azathioprine due to complains of GI upset due to mycophenolate mofetil. In initial 2 months there was moderate bone-marrow suppression, but afterwards there was severe bone-marrow suppression. Lastly TLC reached 300 /mm3 and Hb was 3.8 g/dL and that was life-threatening condition. The patient was managed in ICU with inj. Grafeel under strict hygienic conditions. The patient was recovered successfully with necessary conservative managements during admission. In my case, causality of azathioprine was “definite/ certain” as per Narenjo scale. Seriousness of the reaction was “life- threatening”.