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Gaillard C, Gatault P, Uhl M, Bourgi A, Bruyère F. Are drain essentials in kidney transplantation? Analysis of risk factors affecting the postoperative drainage. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102708. [PMID: 39089471 DOI: 10.1016/j.fjurol.2024.102708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/01/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The routine drain placement following renal transplantation is currently under debate. Its benefit is uncertain and may cause complications, particularly infectious ones. Some renal transplant patients have low-productive drains, that might be unnecessary. The objective of this study is to bring to light factors influencing drain volume in kidney transplantation. MATERIALS AND METHODS All kidney transplant patients in Tours between 2019 and 2020 were included. The characteristics of the two groups were analyzed: patients with low-productive redons (quantification less than 100mL/24h,) and patients with productive redons (≥ 100mL/24h). Univariate and multivariate analyses by logistic regression were performed to look for risk factors associated with productive drainage. RESULTS One hundred and eighty-nine patients were included (67 in the low-productive group and 122 in the productive group). The results in the productive group showed a significantly higher proportion of retransplantation (P=0.015), overweight (P=0.012), low residual diuresis (P=0.041), and a significantly lower proportion of preemptive transplantation (P=0.008) and peritoneal dialysis (P=0.037). After an adjustment, the following variables remained significantly associated with greater drainage: overweight (OR=2.42, P=0.014; 95% CI [1.2-4.94]); retransplantation (OR=3.98, P=0.027; 95% CI [1.27-15.45]), and preemptive transplant (OR=0.22, P=0.013; 95% CI [0.06-0.7]). CONCLUSION The non-implementation of a redon in renal transplantation could be considered, in a selected population of non-overweight patients, with significant residual diuresis for a first transplantation which should be preemptive. This could lead to a randomized controlled trial to determine the real benefits of a routine drain replacement in kidney transplantation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Charles Gaillard
- Department of Urology, University Hospital of Tours, Loire Valley, France.
| | - Philippe Gatault
- Department of Nephrology, University Hospital of Tours, Loire Valley, France.
| | - Marine Uhl
- Department of Urology, University Hospital of Amiens, Hauts-de-France, France.
| | - Ali Bourgi
- Department of Urology, University Hospital of Tours, Loire Valley, France.
| | - Franck Bruyère
- Department of Urology, University Hospital of Tours, Loire Valley, France.
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2
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Mehl SC, Whitlock RS, Ortega RM, Creden S, Iacobas I, Maricevich RS, Rosenberg TL, Rialon KL. No association of sirolimus with wound complications in children with vascular anomalies. J Pediatr Surg 2022:S0022-3468(22)00737-0. [PMID: 36599792 DOI: 10.1016/j.jpedsurg.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sirolimus has demonstrated effectiveness as a treatment option for several types of vascular anomalies; however, it has a potential side effect of delayed surgical wound healing. The purpose of this study was to evaluate the association of sirolimus with postoperative complications in the pediatric vascular anomaly population. METHODS A retrospective cohort study was performed for children with a vascular anomaly who underwent excision or debulking of the anomaly from 2015 to 2020. Patient demographics, vascular anomaly characteristics, operative variables, sirolimus dosing information, and perioperative outcomes were collected. Univariate analysis was performed to compare outcomes based on the administration of sirolimus. RESULTS Forty-seven patients with vascular anomalies underwent 57 surgical procedures (36 without perioperative sirolimus, 21 with perioperative sirolimus). The median age at the time of surgery was seven years (IQR 1.7-14.0). The most common anomalies were lymphatic and venolymphatic malformations. Of the patients administered perioperative sirolimus, the median preoperative and postoperative sirolimus levels were comparable (preoperative 6.9 ng/mL (IQR 4.9-10.1), postoperative 6.5 ng/mL (IQR 4.7-9.4)). The rate of postoperative complications (sirolimus 19%, without sirolimus 11%; p = 0.45) and wound complications (sirolimus 14%, without sirolimus 6%; p = 0.26) were comparable between the cohorts. CONCLUSION Our results suggest sirolimus may not significantly increase perioperative complication rates in pediatric patients undergoing resection of their vascular anomaly. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Steven C Mehl
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA.
| | - Richard S Whitlock
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Rachel M Ortega
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Sam Creden
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Ionela Iacobas
- Department of Pediatrics, Division of Hematology and Oncology, Texas Children's Hospital, Houston, TX, USA
| | - Renata S Maricevich
- Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Tara L Rosenberg
- Department of Surgery, Division of Otolaryngology, Texas Children's Hospital, Houston, TX, USA
| | - Kristy L Rialon
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA
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3
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Abu El Hawa AA, Bekeny JC, Dekker PK, Zolper EG, Tirrell AR, Kennedy CJ, Walters ET, Bovill JD, Fan KL, Attinger CE, Steinberg JS, Abrams PL, Evans KK. Surgical Management of Lower Extremity Wounds in the Solid Organ Transplant Patient Population: Surgeon Beware. Adv Wound Care (New Rochelle) 2022; 11:10-18. [PMID: 33487096 PMCID: PMC9831248 DOI: 10.1089/wound.2020.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: To evaluate our institutional outcomes of surgical management of lower extremity (LE) wounds in the solid organ transplant recipient population. Approach: An 8-year retrospective review was conducted for all solid organ transplantation (SOT) recipients with LE wounds necessitating surgical management at our tertiary limb salvage center. Outcomes of interest included wound healing, surgical treatment, progression to amputation, and amputation level. Factors contributing to amputation progression were analyzed. The article adheres to the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results: Sixty-four SOT recipients underwent surgical management for their LE wounds between 2010 and 2018. Median number of surgeries per patient was 5 (interquartile range = 2-8); 47 of 64 patients (73.4%) underwent amputation, and 17 of 64 patients (26.6%) underwent nonamputation surgical management. In the amputation group, the majority of primary amputations were minor (42/47, 89.4%); 24 of 42 (57.1%) patients progressed to a higher amputation level, 16 of 42 (38.1%) healed after their index procedure, and 2 of 42 (4.8%) were lost to follow-up (LTFU) after their primary minor amputation. Five of 47 (10.6%) patients undergoing amputations required primary below-knee amputations. In the nonamputation group, 15 of 17 (88.2%) healed, 1 of 17 (5.9%) expired, and 1 of 17 (5.9%) was LTFU. Innovation: To identify the outcomes of patients undergoing surgical management for LE wounds after SOT and elucidate clinical factors that impact the rate of limb salvage. Conclusions: This is the first comprehensive analysis of LE wounds in the transplant population. Our analysis indicates high rates of failed minor amputation, and frequent progression to major amputation in SOT patients. Preexisting comorbidities and immunosuppressive regimens complicate limb salvage; therefore, further research is warranted to optimize surgical LE wound management in this population.
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Affiliation(s)
| | - Jenna C. Bekeny
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Paige K. Dekker
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Elizabeth G. Zolper
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Abigail R. Tirrell
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Christopher J. Kennedy
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Elliot T. Walters
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - John D. Bovill
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Kenneth L. Fan
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Christopher E. Attinger
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - John S. Steinberg
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Peter L. Abrams
- Department of Transplant Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Karen K. Evans
- Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Correspondence: Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA .
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Catar RA, Wischnewski O, Chen L, Heidecke H, Rutz C, Schülein R, Dragun D, Philippe A, Kusch A. Non-HLA antibodies targeting angiotensin II type 1 receptors and endothelin-1 type A receptors impair endothelial repair via a β2-arrestin link to the mTOR pathway. Kidney Int 2021; 101:498-509. [PMID: 34757123 DOI: 10.1016/j.kint.2021.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 01/03/2023]
Abstract
Functional non-HLA antibodies (antibodies to non-human leukocyte antigens) targeting the G protein-coupled receptors angiotensin II type 1 receptor (AT1R) and endothelin-1 type A receptor (ETAR) are implicated in the pathogenesis of transplant vasculopathy. While ERK signaling (a regulator of cell growth) may represent a general cellular response to agonist stimulation, the molecular link between receptor stimulation and development of vascular obliteration has not been fully established. Here we hypothesize involvement of the versatile adaptor proteins, β-arrestins, and the major regulator of cell growth, PI3K/mTOR signaling, in impaired endothelial repair. To test this, human microvascular endothelial cells were treated with AT1R/ETAR antibodies isolated from patients with kidney transplant vasculopathy. These antibodies activated both mTOR complexes via AT1R and ETAR in a PI3K-dependent and ERK-independent manner. The mTOR inhibitor, rapamycin, completely abolished activation of mTORC1 and mTORC2 after long-term treatment with receptor antibodies. Imaging studies revealed that β2- but not β1-arrestin was recruited to ETAR in response to ET1 and patient antibodies but not with antibodies isolated from healthy individuals. Silencing of β2-arrestin by siRNA transfection significantly reduced ERK1/2 and mTORC2 activation. Non-HLA antibodies impaired endothelial repair by AT1R- and ETAR-induced mTORC2 signaling. Thus, we provide evidence that functional AT1R/ETAR antibodies induce ERK1/2 and mTOR signaling involving β2-arrestin in human microvascular endothelium. Hence, our data may provide a translational rational for mTOR inhibitors in combination with receptor blockers in patients with non-HLA receptor recognizing antibodies.
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Affiliation(s)
- Rusan Ali Catar
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik m. S. Nephrologie und internistische Intensivmedizin, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Cardiovascular Research, Charitéplatz 1, Berlin, Germany.
| | - Oskar Wischnewski
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik m. S. Nephrologie und internistische Intensivmedizin, Berlin, Germany
| | - Lei Chen
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik m. S. Nephrologie und internistische Intensivmedizin, Berlin, Germany; Department of Nephrology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai City, Guandong Province, People's Republic of China
| | | | - Claudia Rutz
- Leibniz Forschungsinstitut für Molekulare Pharmakologie im Forschungsverbund Berlin e.V., Berlin, Germany
| | - Ralf Schülein
- Leibniz Forschungsinstitut für Molekulare Pharmakologie im Forschungsverbund Berlin e.V., Berlin, Germany
| | - Duska Dragun
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik m. S. Nephrologie und internistische Intensivmedizin, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Cardiovascular Research, Charitéplatz 1, Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, Berlin, Germany
| | - Aurélie Philippe
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik m. S. Nephrologie und internistische Intensivmedizin, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Cardiovascular Research, Charitéplatz 1, Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, Berlin, Germany
| | - Angelika Kusch
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik m. S. Nephrologie und internistische Intensivmedizin, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Cardiovascular Research, Charitéplatz 1, Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.
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5
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Farag A, Gaynor JJ, Serena G, Ciancio G. Evidence to support a drain-free strategy in kidney transplantation using a retrospective comparison of 500 consecutively transplanted cases at a single center. BMC Surg 2021; 21:74. [PMID: 33541328 PMCID: PMC7863357 DOI: 10.1186/s12893-021-01081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value. Objectives To determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors. Methods Retrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. did (Drain, D) receive a drain at the time of transplant was performed. The primary outcome was the development of any wound complication (superficial or deep) during the first 12 months post-transplant. Secondary outcomes included the development of superficial wound complications, deep wound complications, DGF, and graft loss during the first 12 months post-transplant. Results 388 and 112 recipients had DF/D, respectively. DF-recipients were significantly more likely to be younger, not have pre-transplant diabetes, receive a living donor kidney, receive a kidney-alone transplant, have a shorter duration of dialysis, shorter mean cold-ischemia-time, and greater pre-transplant use of anticoagulants/antiplatelets. Wound complications were 4.6% (18/388) vs. 5.4% (6/112) in DF vs. D groups, respectively (P = 0.75). Superficial wound complications were observed in 0.8% (3/388) vs. 0.0% (0/112) in DF vs. D groups, respectively (P = 0.35). Deep wound complications were observed in 4.1% (16/388) vs. 5.4% ((6/112) in DF vs. D groups, respectively (P = 0.57). Higher recipient body mass index and ≥ 1 year of pre-transplant dialysis were associated in multivariable analysis with an increased incidence of wound complications. Once the prognostic influence of these 2 factors were controlled, there was still no notable effect of drain use (yes/no). The lack of prognostic effect of drain use was similarly observed for the other clinical outcomes. Conclusions In a relatively large cohort of renal transplant recipients, routine surgical drain use appears to offer no distinct prognostic advantage.
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Affiliation(s)
- Ahmed Farag
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Surgery, Zagazig University School of Medicine, Zagazig, Egypt
| | - Jeffrey J Gaynor
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giuseppe Serena
- Department of Surgery, Nassau University Medical Center, East Meadow, NY, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. .,Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA. .,Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA. .,Department of Surgery and Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. .,Miami Transplant Institute, 1801 NW 9th Ave, 7th Floor, Miami, FL, 33136, USA.
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6
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Ferrer-Fàbrega J, Fernández-Cruz L. Exocrine drainage in pancreas transplantation: Complications and management. World J Transplant 2020; 10:392-403. [PMID: 33437672 PMCID: PMC7769732 DOI: 10.5500/wjt.v10.i12.392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this minireview is to compare various pancreas transplantation exocrine drainage techniques i.e., bladder vs enteric. Both techniques have different difficulties and complications. Numerous comparisons have been made in the literature between exocrine drainage techniques throughout the history of pancreas transplantation, detailing complications and their impact on graft and patient survival. Specific emphasis has been made on the early postoperative management of these complications and the related surgical infections and their consequences. In light of the results, a number of bladder-drained pancreas grafts required conversion to enteric drainage. As a result of technical improvements, outcomes of the varied enteric exocrine drainage techniques (duodenojejunostomy, duodenoduodenostomy or gastric drainage) have also been discussed i.e., assessing specific risks vs benefits. Pancreatic exocrine secretions can be drained to the urinary or intestinal tracts. Until the late 1990s the bladder drainage technique was used in the majority of transplant centers due to ease of monitoring urine amylase and lipase levels for evaluation of possible rejection. Moreover, bladder drainage was associated at that time with fewer surgical complications, which in contrast to enteric drainage, could be managed with conservative therapies. Nowadays, the most commonly used technique for proper driving of exocrine pancreatic secretions is enteric drainage due to the high rate of urological and metabolic complications associated with bladder drainage. Of note, 10% to 40% of bladder-drained pancreata eventually required enteric conversion at no detriment to overall graft survival. Various surgical techniques were originally described using the small bowel for enteric anastomosis with Roux-en-Y loop or a direct side-to-side anastomosis. Despite the improvements in surgery, enteric drainage complication rates ranging from 2%-20% have been reported. Treatment depends on the presence of any associated complications and the condition of the patient. Intra-abdominal infection represents a potentially very serious problem. Up to 30% of deep wound infections are associated with an anastomotic leak. They can lead not only to high rates of graft loss, but also to substantial mortality. New modifications of established techniques are being developed, such as gastric or duodenal exocrine drainage. Duodenoduodenostomy is an interesting option, in which the pancreas is placed behind the right colon and is oriented cephalad. The main concern of this technique is the challenge of repairing the native duodenum when allograft pancreatectomy is necessary. Identification and prevention of technical failure remains the main objective for pancreas transplantation surgeons. In conclusion, despite numerous techniques to minimize exocrine pancreatic drainage complications e.g., leakage and infection, no universal technique has been standardized. A prospective study/registry analysis may resolve this.
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Affiliation(s)
- Joana Ferrer-Fàbrega
- HepatoBiliaryPancreatic Surgery and Liver and Pancreas Transplantation Department, ICMDM, Hospital Clinic Barcelona, University of Barcelona, Barcelona Clinic Liver Cancer Group, August Pi i Sunyer Biomedical Research Institute, Barcelona 08036, Barcelona, Spain
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7
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Ruiz R, Cox T, McKenna GJ, Onaca N, Testa G, Fernandez H, Bayer J, Wall A, Martinez E, Gupta A, DiNubila JM, Jennings N, Wicklund K. Effect of subcutaneous tissue depth on outcomes of kidney transplantation. Proc (Bayl Univ Med Cent) 2020; 34:237-241. [PMID: 33678955 DOI: 10.1080/08998280.2020.1852835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Although post-kidney transplant (KT) wound complications are associated with elevated body mass index (BMI), BMI is not an accurate surrogate of obesity. On the other hand, subcutaneous depth (SQD) measurement is a direct marker of truncal obesity. We examined outcomes of differing intraoperative SQD measurements in 113 KT-only recipients over 20 months. Recipients' median age was 51 years; median BMI, 28 kg/m2; and mean SQD, 2.9 cm. Patients were stratified into groups of SQD ≤2.5 cm, >2.5-5 cm, and >5 cm. An SQD of >2.5 to 5 cm correlated with a BMI of 30 kg/m2 (obesity) and an SQD >5 cm correlated with a BMI >35 kg/m2 (severe obesity). Degree of SQD was not associated with more frequent technical complications such as fascial dehiscence, lymphocele formation, renal artery thrombosis/stenosis, urine leak, or ureteral stenosis. However, an SQD >2.5 cm was a risk factor for requiring a wound vacuum-assisted closure device. There was no difference in graft or patient survival among the three SQD groups. Obesity, as measured directly by SQD, was not associated with increased technical complications or poor outcomes after KT. As expected, there was a higher incidence of wound complications in the higher SQD groups requiring intervention.
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Affiliation(s)
- Richard Ruiz
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas
| | - Thomas Cox
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas
| | - Gregory J McKenna
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Nicholas Onaca
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Giuliano Testa
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Hoylan Fernandez
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas
| | - Johanna Bayer
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Anji Wall
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Eric Martinez
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Amar Gupta
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - J Michelle DiNubila
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas
| | - Nicole Jennings
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas
| | - Kari Wicklund
- Department of Transplant Surgery, Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas
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8
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Garming Legert K, Ringdén O, Remberger M, Törlén J, Mattsson J, Dahllöf G. Oral mucositis after tacrolimus/sirolimus or cyclosporine/methotrexate as graft-versus-host disease prophylaxis. Oral Dis 2020; 27:1217-1225. [PMID: 33012083 PMCID: PMC8247364 DOI: 10.1111/odi.13663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/02/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To determine whether treatment with tacrolimus plus sirolimus (Tac/Sir) as a prophylaxis for graft-versus-host disease worsens severe oral mucositis and delays healing compared to cyclosporine plus methotrexate (CsA/Mtx) following haematopoietic stem cell transplantation. SUBJECTS AND METHODS The study comprised 141 patients: 73 randomized to receive Tac/Sir and 68 to receive CsA/Mtx. The oral mucositis assessment scale and toxicity grading according to WHO were used to assess the severity, peak and duration of oral mucositis from the day -3 to day 24 post-transplant. RESULTS Eighty-seven patients developed oral mucositis in the first 24 days post-transplant. No significant difference in oral mucositis severity between the Tac/Sir and CsA/Mtx groups was observed. The peak oral mucositis score occurred on day 10 in both groups. Although oral mucositis scores had returned to baseline in the CsA/Mtx group on day 24 post-transplant, no significant difference compared with the Tac/Sir group was found. CONCLUSIONS The introduction of tacrolimus/sirolimus as a graft-versus-host disease prophylaxis in haematopoietic stem cell transplantation increased neither the incidence nor severity of oral mucositis compared with cyclosporine/methotrexate. Furthermore, oral mucositis healing was not prolonged and followed the same time pattern as cyclosporine/methotrexate.
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Affiliation(s)
| | - Olle Ringdén
- Department of Clinical Sciences, Intervention and Technology, Translational cell therapy research group, Karolinska Institutet, Stockholm, Sweden
| | - Mats Remberger
- Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Törlén
- Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Mattsson
- Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden.,Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, University of Toronto, Toronto, Canada.,Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Göran Dahllöf
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Center for Oral Health Services and Research, Trondheim, Norway
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9
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Is recipient's body mass index a determinant of short term complications in early renal transplantation? Prog Urol 2020; 30:663-674. [DOI: 10.1016/j.purol.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022]
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10
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Bar M, Ott SM, Lewiecki EM, Sarafoglou K, Wu JY, Thompson MJ, Vaux JJ, Dean DR, Saag KG, Hashmi SK, Inamoto Y, Dholaria BR, Kharfan-Dabaja MA, Nagler A, Rodriguez C, Hamilton BK, Shah N, Flowers MED, Savani BN, Carpenter PA. Bone Health Management After Hematopoietic Cell Transplantation: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2020; 26:1784-1802. [PMID: 32653624 DOI: 10.1016/j.bbmt.2020.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
Bone health disturbances commonly occur after hematopoietic cell transplantation (HCT) with loss of bone mineral density (BMD) and avascular necrosis (AVN) foremost among them. BMD loss is related to pretransplantation chemotherapy and radiation exposure and immunosuppressive therapy for graft-versus-host-disease (GVHD) and results from deficiencies in growth or gonadal hormones, disturbances in calcium and vitamin D homeostasis, as well as osteoblast and osteoclast dysfunction. Although the pathophysiology of AVN remains unclear, high-dose glucocorticoid exposure is the most frequent association. Various societal treatment guidelines for osteoporosis exist, but the focus is mainly on menopausal-associated osteoporosis. HCT survivors comprise a distinct population with unique comorbidities, making general approaches to bone health management inappropriate in some cases. To address a core set of 16 frequently asked questions (FAQs) relevant to bone health in HCT, the American Society of Transplant and Cellular Therapy Committee on Practice Guidelines convened a panel of experts in HCT, adult and pediatric endocrinology, orthopedics, and oral medicine. Owing to a lack of relevant prospective controlled clinical trials that specifically address bone health in HCT, the answers to the FAQs rely on evidence derived from retrospective HCT studies, results extrapolated from prospective studies in non-HCT settings, relevant societal guidelines, and expert panel opinion. Given the heterogenous comorbidities and needs of individual HCT recipients, answers to FAQs in this article should be considered general recommendations, with good medical practice and judgment ultimately dictating care of individual patients. Readers are referred to the Supplementary Material for answers to additional FAQs that did not make the core set.
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Affiliation(s)
- Merav Bar
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
| | - Susan M Ott
- Department of Medicine, University of Washington, Seattle, Washington
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, New Mexico; Bone Health TeleECHO, UNM Health Sciences Center, Albuquerque, New Mexico
| | - Kyriakie Sarafoglou
- Department of Pediatrics, Divisions of Endocrinology and Genetics & Metabolism, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Experimental & Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | - Joy Y Wu
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew J Thompson
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jonathan J Vaux
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
| | - David R Dean
- Department of Oral Medicine, University of Washington School of Dentistry, Seattle, Washington
| | - Kenneth G Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Bhagirathbhai R Dholaria
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Arnon Nagler
- Bone Marrow Transplantation Department, Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Cesar Rodriguez
- Department of Internal Medicine Hematology and Oncology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Nina Shah
- Division of Hematology-Oncology, University of California, San Francisco, California
| | - Mary E D Flowers
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Bipin N Savani
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
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11
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Vigués F, Bonet X, Etcheverry B, Fiol M, Suárez-Novo JF, Breda A, Riera L. Orthotopic robot-assisted kidney transplantation: first case report. World J Urol 2020; 39:2811-2813. [PMID: 32468111 DOI: 10.1007/s00345-020-03269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Francesc Vigués
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain.
| | - X Bonet
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - B Etcheverry
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - M Fiol
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - J F Suárez-Novo
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - A Breda
- Fundació Puigvert, Barcelona, Spain
| | - L Riera
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
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12
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Girman P, Lipár K, Kočík M, Voska L, Kožnarová R, Marada T, Lánská V, Saudek F. Sirolimus vs mycophenolate mofetil (MMF) in primary combined pancreas and kidney transplantation. Results of a long-term prospective randomized study. Am J Transplant 2020; 20:779-787. [PMID: 31561278 DOI: 10.1111/ajt.15622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/15/2019] [Accepted: 09/20/2019] [Indexed: 01/25/2023]
Abstract
The study was intended to compare pancreas graft survival rates in two groups of pancreas and kidney transplant recipients prospectively randomized to treatment either with sirolimus or MMF. From 2002 to 2013, 238 type 1 diabetic recipients with end-stage kidney disease were randomized 1:1 to sirolimus or MMF treatment. Noncensored pancreas survival at 5 years was 76.4 and 71.6% for sirolimus and MMF groups, respectively (P > .05). Death-censored pancreas survival was better in the sirolimus group (P = .037). After removal of early graft losses pancreas survival did not differ between groups (MMF 83.1% vs sirolimus 91.6%, P = .11). Nonsignificantly more grafts were lost due to rejection in the MMF group (10 vs 5; P = .19). Cumulative patient 5-year survival was 96% in the MMF group and 91% in the sirolimus group (P > .05). Five-year cumulative noncensored kidney graft survival rates did not statistically differ (85.6% in the sirolimus group and 88.8% in MMF group). Recipients treated with MMF had significantly more episodes of gastrointestinal bleeding (7 vs 0, P = .007). More recipients in the sirolimus group required corrective surgery due to incisional hernias (21 vs 12, P = .019). ClinicalTrials No.: NCT03582878.
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Affiliation(s)
- Peter Girman
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Květoslav Lipár
- Transplantation Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Matěj Kočík
- Transplantation Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Luděk Voska
- Clinical and Transplant Pathology Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Radomíra Kožnarová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomáš Marada
- Transplantation Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Věra Lánská
- Department for Data Analysis and Statistics, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - František Saudek
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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13
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Surgical Site Infections Complicating the Use of Negative Pressure Wound Therapy in Renal Transplant Recipients. Case Rep Transplant 2019; 2019:2452857. [PMID: 31662941 PMCID: PMC6778947 DOI: 10.1155/2019/2452857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/29/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022] Open
Abstract
Surgical site infections (SSI) of the abdominal wall in renal transplant recipients can on occasion require management with negative pressure wound therapy (NPWT). This is often successful, with a low risk of further complications. However, we describe three cases in which persistent or recurrent surgical site sepsis occurred, whilst NPWT was being deployed in adults with either wound dehiscence or initial SSI. This type of complication in the setting of NPWT has not been previously described in renal transplant recipients. Our case series demonstrates that in immunosuppressed transplant recipients, there may be ineffective microbial or bacterial bioburden clearance associated with the NPWT, which can lead to further infections. Hence recognition for infections in renal transplant patients undergoing treatment with NPWT is vital; furthermore, aggressive management of sepsis control with early debridement, antimicrobial use, and reassessment of the use of wound dressing is necessary to reduce the morbidity associated with surgical site infections and NPWT.
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14
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A 3-month, Multicenter, Randomized, Open-label Study to Evaluate the Impact on Wound Healing of the Early (vs Delayed) Introduction of Everolimus in De Novo Kidney Transplant Recipients, With a Follow-up Evaluation at 12 Months After Transplant (NEVERWOUND Study). Transplantation 2019; 104:374-386. [PMID: 31335776 PMCID: PMC7004468 DOI: 10.1097/tp.0000000000002851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The risk of wound healing complications (WHCs) and the early use of mammalian target of rapamycin inhibitors after kidney transplantation (KT) have not been fully addressed. METHODS The NEVERWOUND study is a 3-month, multicenter, randomized, open-label study designed to evaluate whether a delayed (ie, 28 ± 4 d posttransplant) immunosuppression regimen based on everolimus (EVR) reduces the risk of WHC versus EVR started immediately after KT. Secondary endpoints were treatment failure (biopsy-proven acute rejection, graft loss, or death), delayed graft function, patient and graft survival rates, and renal function. RESULTS Overall, 394 KT recipients were randomized to receive immediate (N = 197) or delayed (N = 197) EVR after KT. At 3 months, WHC-free rates in the immediate EVR versus delayed EVR arm, considering the worst- and best-case scenario approach, were 0.68 (95% confidence interval [CI], 0.62-0.75) versus 0.62 (95% CI, 0.55-0.68) (log-rank P = 0.56) and 0.70 (95% CI, 0.64-0.77) versus 0.72 (95% CI, 0.65-0.78) (log-rank P = 0.77), respectively. The 3- and 12-month treatment failure rates, delayed graft function and renal function, and patient and graft survival were not different between the arms. CONCLUSIONS The early introduction of EVR after KT did not increase the risk of WHC, showing good efficacy and safety profile.
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15
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Hwang DY, Lee GR, Kim JH, Lee YS. Single-incision laparoscopic ileostomy is a safe and feasible method of fecal diversion for anastomotic leakage following laparoscopic low anterior resection. Ann Surg Treat Res 2018; 95:319-323. [PMID: 30505823 PMCID: PMC6255752 DOI: 10.4174/astr.2018.95.6.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 01/03/2023] Open
Abstract
Purpose Currently, many operations are performed using the single-incision laparoscopic method. Although there have been recent reports on single-incision laparoscopic ileostomy, none have compared this method to conventional laparoscopic ileostomy. This study aimed to assess the safety and feasibility of single-incision laparoscopic ileostomy for anastomotic leakage following laparoscopic low anterior resections. Methods From April 2012 to April 2017, 38 patients underwent laparoscopic ileostomy (single-incision; 19 patients referred to as group A, conventional laparoscopy; 19 patients referred to as group B) for anastomotic leakage following laparoscopic low anterior resection. We analyzed surgical and clinical outcomes between the 2 groups. Patients in whom a protective ileostomy was carried out during the initial laparoscopic low anterior resection were excluded from this study. Results No significant differences were observed between the 2 groups in terms of patient demographics and initial operation details. Incisional surgical site infections occurred less in group A than in group B (2 of 19 vs. 9 of 19, P = 0.029). The median ileostomy operation time, amount of intraoperative bleeding, parastomal hernia ratio, hospital stay duration after ileostomy, postoperative pain score were not significantly different between the 2 groups. Conclusion Single-incision laparoscopic ileostomy is safe and feasible method of fecal diversion for anastomotic leakage following laparoscopic low anterior resection.
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Affiliation(s)
- Duk Yeon Hwang
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Gyeo Ra Lee
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Ji Hoon Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yoon Suk Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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Cutaneous Complications in Recipients of Lung Transplants: A Pictorial Review. Chest 2018; 155:178-193. [PMID: 30201407 DOI: 10.1016/j.chest.2018.08.1060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/16/2018] [Indexed: 12/26/2022] Open
Abstract
Lung transplant is now an established modality for a broad spectrum of end-stage pulmonary diseases. According to the International Society for Heart and Lung Transplantation Registry, more than 50,000 lung transplants have been performed worldwide, with nearly 11,000 recipients of lung transplants alive in the United States. With the increasing use of lung transplant, pulmonologists must be cognizant of the common as well as the unique posttransplant dermatologic complications. Immunosuppression, infections, and a variety of medications and environmental exposures can contribute to these complications. This review aims to provide representative pictures and describe the pathogenesis, epidemiologic characteristics, and clinical manifestations of dermatologic complications encountered among recipients of lung transplants.
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17
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Pacovsky J, Hyspler R, Husek P, Navratil P, Brodak M. Colloid Osmotic Pressure Participates on the Post-transplant Lymphocele Pathogenesis. Transplant Proc 2018; 50:3422-3425. [PMID: 30577216 DOI: 10.1016/j.transproceed.2018.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
The aim of the study was to evaluate the role of colloid osmotic pressure in post-transplant lymphocele pathogenesis. We have analyzed total plasmatic protein and albumin levels, and electrophoresis has been completed in blood samples before transplantation and in days 3 and 14 after transplantation in 50 patients with lymphocele (Lymphocele) and 198 patients without lymphocele (control), respectively. Colloid osmotic pressure (COP) was calculated according to the Hoefs formula. Statistically significant differences were confirmed in albumin levels (42.2 respectively 44.8 g/L) before transplantation (day 0); in total protein (52.5 resp. 55.5 g/L), in albumin (30.1 resp. 32.1 g/L), and COP (15.6 respectively 17.7 kPa) in day 3; and in total protein (52.8 resp. 58.9 g/L), in albumin (30.5 respectively 35.4 g/L), in COP (16.1 respectively 21.2 kPa) in day 14. A potentially critical albumin level was established in 44.1 g/L in the blood analyzed, but its sensitivity was only 62%. The main risk element for the lymphocele formation remains the surgeon's hand. We can proclaim the role of proteins and their COP in the post-transplant lymphocele formation as one of possible pathogenetic cofactors. It is responsible for the impaired mechanisms of the reabsorption the lymph back to the tissues. Better metabolic care could help to reduce incidence of this surgical complication.
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Affiliation(s)
- J Pacovsky
- Department of Urology, University Hospital, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Department of Surgery, Charles University, Hradec Kralove, Czech Republic.
| | - R Hyspler
- Department of Clinical Biochemistry and Diagnostics, University Hospital, Hradec Kralove, Czech Republic
| | - P Husek
- Department of Urology, University Hospital, Hradec Kralove, Czech Republic
| | - P Navratil
- Department of Urology, University Hospital, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Department of Surgery, Charles University, Hradec Kralove, Czech Republic
| | - M Brodak
- Department of Urology, University Hospital, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Department of Surgery, Charles University, Hradec Kralove, Czech Republic
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18
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Rashid-Farokhi F, Afshar H. Lymphedema of the Transplanted Kidney and Abdominal Wall with Ipsilateral Pleural Effusion Following Kidney Biopsy in a Patient Treated with Sirolimus: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1370-1376. [PMID: 29269724 PMCID: PMC5747954 DOI: 10.12659/ajcr.905962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/06/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in organ transplant recipients. Although mTOR inhibitors are well tolerated, their adverse effects have been reported. Sirolimus treatment in transplant recipients has been reported to be associated with lymphedema of the skin and subcutaneous tissues, and with pleural effusion, but edema of internal organs and organomegaly have not been previously reported. A case is presented lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy in a patient treated with sirolimus. CASE REPORT A 32-year-old woman with a history of end-stage renal disease of unknown etiology had undergone right renal transplantation from an unrelated living donor, eight years previously. She was referred to our hospital with dyspnea, localized abdominal pain, and swelling of the transplanted kidney. The symptoms appeared following a kidney biopsy and the replacement of cyclosporin with sirolimus four months previously. On examination, she had localized swelling of the abdominal wall overlying the transplanted kidney, and a right pleural effusion. Hydronephrosis and nephrotic syndrome were excluded as causes of kidney enlargement. Following the withdrawal of sirolimus therapy her symptoms resolved within three months. CONCLUSIONS A case is described of lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy attributed to her change in anti-rejection therapy to sirolimus. This case report should raise awareness of this unusual complication of sirolimus anti-rejection therapy and its possible effects on the lymphatic system.
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Affiliation(s)
- Farin Rashid-Farokhi
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Nephrology, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Telemedicine Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hale Afshar
- Respiratory Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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19
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Ilyas M, Colegio OR, Kaplan B, Sharma A. Cutaneous Toxicities From Transplantation-Related Medications. Am J Transplant 2017; 17:2782-2789. [PMID: 28452165 DOI: 10.1111/ajt.14337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/22/2017] [Accepted: 04/22/2017] [Indexed: 01/25/2023]
Abstract
Despite the abundance of information on cutaneous malignancies associated with solid organ transplantation in the transplant literature, there is limited information regarding nonmalignant skin changes after transplantation. There are numerous skin toxicities secondary to immunosuppressive and other transplant-related medications that can vary in presentation, severity, and prognosis. To limit associated morbidity and mortality, solid organ transplant recipient care providers should effectively identify and manage cutaneous manifestations secondary to drug toxicity. Toxicities from the following transplant-related medications will be discussed: antithymocyte globulins, systemic steroids, cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, mammalian target of rapamycin inhibitors sirolimus and everolimus, basiliximab and daclizumab, belatacept, and voriconazole.
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Affiliation(s)
- M Ilyas
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
| | - O R Colegio
- Departments of Dermatology, Pathology and Surgery, Yale University, New Haven, CT
| | - B Kaplan
- Department of Nephrology, Mayo Clinic Arizona, Scottsdale, AZ
| | - A Sharma
- Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ
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20
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Shrestha BM. Systematic review of the negative pressure wound therapy in kidney transplant recipients. World J Transplant 2016; 6:767-773. [PMID: 28058229 PMCID: PMC5175237 DOI: 10.5500/wjt.v6.i4.767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 10/23/2016] [Accepted: 11/17/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To review negative pressure wound therapy (NPWT) as an important addition to the conventional methods of wound management.
METHODS A systematic review, performed by searching the PubMed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation (KT) patients (range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.
RESULTS No complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.
CONCLUSION Negative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.
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21
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Boire TC, Balikov DA, Lee Y, Guth CM, Cheung-Flynn J, Sung HJ. Biomaterial-Based Approaches to Address Vein Graft and Hemodialysis Access Failures. Macromol Rapid Commun 2016; 37:1860-1880. [PMID: 27673474 PMCID: PMC5156561 DOI: 10.1002/marc.201600412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/15/2016] [Indexed: 12/19/2022]
Abstract
Veins used as grafts in heart bypass or as access points in hemodialysis exhibit high failure rates, thereby causing significant morbidity and mortality for patients. Interventional or revisional surgeries required to correct these failures have been met with limited success and exorbitant costs, particularly for the US Centers for Medicare & Medicaid Services. Vein stenosis or occlusion leading to failure is primarily the result of neointimal hyperplasia. Systemic therapies have achieved little long-term success, indicating the need for more localized, sustained, biomaterial-based solutions. Numerous studies have demonstrated the ability of external stents to reduce neointimal hyperplasia. However, successful results from animal models have failed to translate to the clinic thus far, and no external stent is currently approved for use in the US to prevent vein graft or hemodialysis access failures. This review discusses current progress in the field, design considerations, and future perspectives for biomaterial-based external stents. More comparative studies iteratively modulating biomaterial and biomaterial-drug approaches are critical in addressing mechanistic knowledge gaps associated with external stent application to the arteriovenous environment. Addressing these gaps will ultimately lead to more viable solutions that prevent vein graft and hemodialysis access failures.
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Affiliation(s)
- Timothy C Boire
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Daniel A Balikov
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Yunki Lee
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
| | - Christy M Guth
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Joyce Cheung-Flynn
- Division of Vascular Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Hak-Joon Sung
- Department of Biomedical Engineering, Vanderbilt University, 37235, Nashville, TN, USA
- Severance Biomedical Science Institute, College of Medicine, Yonsei University, Seoul, 120-752, Republic of Korea
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22
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La transplantation rénale et ses défis. Prog Urol 2016; 26:1001-1044. [PMID: 27720627 DOI: 10.1016/j.purol.2016.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 01/09/2023]
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23
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Küper MA, Trütschel S, Weinreich J, Königsrainer A, Beckert S. Growth hormone abolishes the negative effects of everolimus on intestinal wound healing. World J Gastroenterol 2016; 22:4321-4329. [PMID: 27158200 PMCID: PMC4853689 DOI: 10.3748/wjg.v22.i17.4321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/10/2016] [Accepted: 03/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether the simultaneous treatment with human growth hormone (hGH) abolishes the negative effects of everolimus on anastomotic healing.
METHODS: Forty-eight male Sprague-Dawley-rats were randomized to three groups of 16 animals each (I: vehicle; II: everolimus 3 mg/kg po; III: everolimus 3 mg/kg po + hGH 2.5 mg/kg sc). Animals were pre-treated with hGH and/or everolimus daily for seven days. Then a standard anastomosis was created in the descending colon and treatment was continued for another seven days. The anastomosis was resected in toto and the bursting pressure was assessed as a mechanical parameter of intestinal healing. Moreover, biochemical (Hydroxyproline, PCNA, MPO, MMP-2 and MMP-9) and histological (cell density, angiogenesis, amount of granulation tissue) parameters of intestinal healing were assessed.
RESULTS: Anastomotic bursting pressure was significantly reduced by everolimus and a simultaneous treatment with hGH resulted in considerably higher values (I: 134 ± 19 mmHg, II: 85 ± 25 mmHg, III: 114 ± 25 mmHg; P < 0.05, I vs II; P = 0.09, I vs III and II vs III) Hydroxyproline concentration was significantly increased by hGH compared to everolimus alone (I: 14.9 ± 2.5 μg/mg, II: 8.9 ± 3.6 μg/mg, III: 11.9 ± 2.8 μg/mg; P < 0.05, I vs II/III and II vs III). The number of MPO-positive cells was reduced significantly by hGH compared to everolimus alone (I: 10 ± 1 n/mm², II: 15 ± 3 n/mm², III: 9 ± 2 n/mm²; P < 0.05, I vs II and II vs III), while the number of PCNA-positive cells were increased by hGH (I: 28 ± 3 /mm², II: 12 ± 3 /mm², III: 26 ± 12 /mm²; P < 0.05, I vs II and II vs III). Corresponding to these biochemical findings, HE-histology revealed significantly increased amount of granulation tissue in hGH-treated animals.
CONCLUSION: Inhibition of intestinal wound healing by everolimus is partially neutralized by simultaeous treatment with hGH. Both inflammation as well as collagen deposition is influenced by hGH.
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Sabet-Baktach M, Schmitz V, Pratschke J. Trauma-Management beim organtransplantierten Patienten. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yang RL, Kurian AW, Winton LM, Weill D, Patel K, Kingham K, Wapnir IL. Addressing inherited predisposition for breast cancer in transplant recipients. J Surg Oncol 2016; 113:605-8. [PMID: 26861253 DOI: 10.1002/jso.24193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 01/23/2016] [Indexed: 11/06/2022]
Abstract
Consideration of prophylactic mastectomy surgery following transplantation requires complex medical decision-making, and bias against elective surgery exists because of concern for post-operative complications. Prevention of cancer in transplant recipients is of utmost importance, given the risks of treating malignancy in an immunosuppressed patient. We present a patient case and review of the literature to support a thorough pre-transplantation evaluation of family history and consideration of prophylactic interventions to safeguard the quality of life of transplant recipients. J. Surg. Oncol. 2016;113:605-608. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rachel L Yang
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Lisa M Winton
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - David Weill
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kapilkumar Patel
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kerry Kingham
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Irene L Wapnir
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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EXP CLIN TRANSPLANTExp Clin Transplant 2016; 14. [DOI: 10.6002/ect.2015.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fockens MM, Alberts VP, Bemelman FJ, van der Pant KAMI, Idu MM. Wound morbidity after kidney transplant. Prog Transplant 2015; 25:45-8. [PMID: 25758800 DOI: 10.7182/pit2015812] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Wound morbidity is an important surgical complication after kidney transplant. OBJECTIVE To assess risk factors for postoperative wound complications and the impact of such complications on outcomes of kidney transplant. DESIGN AND PATIENTS Retrospectively, 108 consecutive kidney transplant patients between January 2010 and December 2010 were included in the analysis. Wound morbidity was defined as a surgical site infection or symptomatic lymphocele requiring intervention. Patient, donor, and surgical characteristics were reviewed. RESULTS Eight lymphoceles and 5 surgical site infections occurred in 12 patients. Risk factors for wound complications were recipient's age (P<.01), body mass index (P=.01), urinary tract infection (P=.01), and prolonged postoperative wound drainage (P=.047). Wound morbidity did not increase the incidence of delayed graft function, acute rejection, graft failure, or mortality. Obesity, recipient's age, urinary tract infection, and prolonged wound drainage are risk factors for wound-related complications. Graft and patient survival rates are comparable between patients with and without wound-related complications.
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Affiliation(s)
- M Matthijs Fockens
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Victor P Alberts
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Karlijn A M I van der Pant
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Mirza M Idu
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
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Amikacin prophylaxis and risk factors for surgical site infection after kidney transplantation. Transplantation 2015; 99:521-7. [PMID: 25254907 DOI: 10.1097/tp.0000000000000381] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. METHODS We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. RESULTS A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. CONCLUSION Amikacin prophylaxis is a useful strategy for preventing SSIs.
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Hulbert AL, Delahunty AJ, Rajab A, Forbes RC, Winters HA. The utilization of sirolimus and the impact on wound-healing complications in obese kidney transplant recipients. Clin Transplant 2014; 27:E521-7. [PMID: 23923974 DOI: 10.1111/ctr.12183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Wound healing is a known complication associated with sirolimus therapy. Previous studies have demonstrated that obesity is a risk factor for wound-healing complications (WHC) in patients receiving sirolimus therapy; however, the incidence has not been defined. METHODS This is a single-center, retrospective cohort study of de novo kidney transplant recipients (KTR) transplanted with a body mass index (BMI) of ≥ 30 kg/m(2) between January 2002 and April 2011 receiving sirolimus vs. sirolimus-free maintenance immunosuppression. RESULTS A total of 317 KTR, 71 sirolimus-free patients and 246 sirolimus patients, were eligible for inclusion. There was no difference in the primary outcome of WHC within six months of transplant (sirolimus 32.1% vs. sirolimus-free 29.6%, p = 0.107). Sirolimus exposure was not found to influence WHC (OR 2.906, 95% CI 0.922-9.160); however, BMI Class II (OR 1.830, 95% CI 1.051-3.186) and Class III (OR 3.154, 95% CI 1.484-6.705) were significant predictors of WHC. There was no difference in WHC between the sirolimus group and sirolimus-free group among patients in obesity Class I (27.3% vs. 15.1%, p = 0.064), Class II (36.6% vs. 34.8%, p = 0.195), or Class III (48.0% vs. 53.3%, p = 0.243). CONCLUSION In our experience, sirolimus does not increase WHC in obese KTR and can be safely used as maintenance immunosuppression immediately following transplant.
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Affiliation(s)
- Amanda L Hulbert
- Department of Pharmacy, Duke University Medical Center, Durham, NC, USA
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Varon NF, Alangaden GJ. Emerging trends in infections among renal transplant recipients. Expert Rev Anti Infect Ther 2014; 2:95-109. [PMID: 15482175 DOI: 10.1586/14787210.2.1.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Outcomes following renal and simultaneous kidney-pancreas transplants have improved significantly due to better surgical techniques and improved modalities of antirejection therapy. However, infection remains a significant cause of morbidity and mortality. The use of new modalities of immunosuppression and routine use of antimicrobial prophylaxis has changed the pattern of infections post-transplantation. Cytomegalovirus remains a significant problem and BK virus has emerged as an important pathogen. New antimicrobial agents are now available to treat infection, however, antimicrobial resistance remains a concern.
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Affiliation(s)
- Nestor F Varon
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI, USA
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Timsit MO, Albiges L, Méjean A, Escudier B. Neoadjuvant treatment in advanced renal cell carcinoma: current situation and future perspectives. Expert Rev Anticancer Ther 2014; 12:1559-69. [DOI: 10.1586/era.12.142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Joung JY, Ha YS, Singer EA, Ercolani MC, Favaretto RL, Lee DH, Kim WJ, Lee KH, Kim IY. Use of a hyaluronic acid-carboxymethylcellulose adhesion barrier on the neurovascular bundle and prostatic bed to facilitate earlier recovery of erectile function after robot-assisted prostatectomy: an initial experience. J Endourol 2013; 27:1230-5. [PMID: 23879531 DOI: 10.1089/end.2013.0345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the efficacy of hyaluronic acid-carboxymethylcellulose (HACM) in facilitating early recovery of erectile function (EF) after radical prostatectomy, we report our initial experience of HACM use on the neurovascular bundle (NVB) after robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS Between 2008 and 2010, 459 consecutive patients who underwent RARP with bilateral nerve-sparing technique were included in this study. Patients were classified into two groups: HACM (group 1; n=162) and non-HACM (group 2; n=287). HACM was delivered to the anatomic location of the NVB after prostate removal. We retrospectively analyzed the surgical outcomes including EF, continence, and perioperative complications. RESULTS At 6 months after surgery, EF recovery rate was 28.5% in group 1 and 17.4% in group 2 (P=0.006). In a subgroup analysis consisting of 225 patients with a preoperative International Index of Erectile Function Short Survey (IIEF)-5 score ≥20, the difference in EF recovery at 6 months was significant with 62.8% in group 1 and 27.0% in group 2 (P=0.002), respectively. HACM use was an independent predictor for EF recovery at 6 months after surgery (odds ratio, 2.735; 95% confidence interval, 1.613-4.638; P<0.001). Age and preoperative IIEF-5 were also independent predictors. No differences in continence at 6 months or perioperative complications were found between the two groups. EF recovery was not different between the two groups after 18 months. CONCLUSIONS HACM use around the NVBs is safe and facilitates early recovery of EF after nerve-sparing RARP. HACM use is more effective in patients with normal preoperative sexual function.
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Affiliation(s)
- Jae Young Joung
- 1 Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, The Cancer Institute of New Jersey , UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Hasegawa J, Hirota M, Kim HM, Mikata S, Shimizu J, Soma Y, Nezu R. Single-incision laparoscopic stoma creation: experience with 31 consecutive cases. Asian J Endosc Surg 2013; 6:181-5. [PMID: 23683320 DOI: 10.1111/ases.12034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/27/2013] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Fecal diversion may be performed using various techniques. Each technique has advantages that affect patient selection. In this report, we report our experience with 31 patients who underwent single-incision laparoscopic stoma creation using only a pre-selected stoma site as the point of port access. METHODS A 2.5-cm skin incision was made at a previously marked stoma site, and two 5-mm trocars were placed into the abdomen through the stoma site. An optional third trocar was inserted at the stoma site only if the bowel needed to be mobilized or if adhesions needed to be divided. After full intra-abdominal exploration, a selected intestinal loop was brought up to the stoma site, and the ostomy was then matured using standard techniques. RESULTS Between April 2009 and March 2012, 31 patients (19 men) with a mean age of 68 years (range, 46-87 years) underwent single-incision laparoscopic stoma creation. Fecal diversion included ileostomy (n = 18) and colostomy (n = 13). There were no intraoperative complications. Two patients (6.5%) required additional port placement in the midline suprapubic area. Conversion to open laparotomy was required in two patients (6.5%) because of the presence of extensive adhesions. Postoperative complications were observed in two patients and included peristomal ileus and dehydration due to high ileostomy output. CONCLUSIONS Single-incision laparoscopic stoma creation is an effective technique that allows full intra-abdominal visualization and bowel mobilization, while reducing the need for additional skin incisions beyond that of the stoma site.
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Lam HD, Mejia J, Soltys KA, Sindhi R, Mazariegos G, Bond G. Right diaphragmatic hernia after liver transplant in pediatrics: a case report and review of the literature. Pediatr Transplant 2013; 17:E77-80. [PMID: 23442132 DOI: 10.1111/petr.12052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 11/29/2022]
Abstract
Diaphragmatic hernias (DH) are an unusual complication after pediatric liver transplantation; however, they have been reported with increased frequency in the past few years. DHs are responsible for nearly half of the small bowel obstructions requiring surgical intervention in this patient population. It has been suggested that the use of a left lobe liver graft, surgical trauma, malnourishment, elevated intra-abdominal pressures, and mTor inhibitors may predispose to development of DH. The use of a segmental graft may increase the recognition of diaphragmatic hernia because the surgically damaged right hemi-diaphragm often remains exposed to underlying viscera, instead of being covered by the right hepatic lobe. Treatment is surgical reduction, with up to 20% of the patients requiring resection of the herniated intestine. Herein we describe a case of DH after left segmental liver transplant in a two- yr-old boy that presented one month post left lobe split liver transplant with abdominal pain, anorexia, and respiratory distress. Just like in the majority of the reported cases, an urgent laparotomy with primary repair was performed. No resection of the herniated segment of intestine was required. For pediatric patients with otherwise unexplained respiratory or gastrointestinal symptoms after a left lateral segment liver transplant, right-sided diaphragmatic hernias should always be high in the differential diagnosis.
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Affiliation(s)
- Hwai-Ding Lam
- Starzl Transplantation Institute, Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA
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de Pablo A, Santos F, Solé A, Borro JM, Cifrian JM, Laporta R, Monforte V, Román A, de la Torre M, Ussetti P, Zurbano F. Recommendations on the use of everolimus in lung transplantation. Transplant Rev (Orlando) 2012; 27:9-16. [PMID: 23276646 DOI: 10.1016/j.trre.2012.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/09/2012] [Indexed: 01/05/2023]
Abstract
The antiproliferative effect of everolimus provides a therapeutic option in the immunosuppression therapy of lung transplantation, by reducing both the risk of acute rejection and the process of progressive fibrosis that determines chronic graft rejection. However, few data on the use of everolimus in lung transplantation have been published to date, and the specific indications of the drug, along with the most adequate time for its introduction or dosing, have not been defined yet. The aim of this article is to propose recommendations for the use of everolimus in lung transplant recipients, including indications, dosing schedules and the use of concomitant immunosuppression. This consensus document has been developed by experts of all the Spanish lung transplant groups from the review of the existing literature and the clinical experience.
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Affiliation(s)
- A de Pablo
- University Hospital, Doce de Octubre, Madrid, Spain.
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Transplantation rénale et receveurs obèses : revue du comité de transplantation de l’Association française d’urologie. Prog Urol 2012; 22:678-87. [DOI: 10.1016/j.purol.2012.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 03/15/2012] [Accepted: 04/30/2012] [Indexed: 01/31/2023]
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Zukowski M, Kotfis K, Biernawska J, Zegan-Barańska M, Kaczmarczyk M, Ciechanowicz A, Brykczyński M, Różański J, Ziętek Z, Nikodemski T, Bohatyrewicz R. Graft infection in kidney recipients and its relation to transplanted kidney function. Transplant Proc 2012; 43:2997-9. [PMID: 21996209 DOI: 10.1016/j.transproceed.2011.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Following kidney transplantation, septic complications are the leading causes of therapeutic failure including recipient death or graft removal. The serum creatinine level is one of the earliest metrics of kidney metabolic function. We examined the influence of graft infection on serum creatinine levels in kidney recipients. STUDY DESIGN We analyzed the function of 220 kidneys transplanted in nine centers in Poland. The kidneys were recovered from 146 multiorgan donors. Donor urea and creatinine levels were within the normal range. We investigated the influence of perioperative graft infection incidence on recipient creatinine levels at 1, 2, 3, 7, 14, 30, 90, and 180 days after kidney transplantation. The association of the serum creatinine level with categorical variables was assessed using either Student t test analysis of variance and multivariate techniques. In all analyses P<.05 indicated statistical significance. RESULTS There were 25 graft infections revealing a significant relationship with increased recipient serum creatinine level after kidney transplantation (P=.003). Multivariate analysis confirmed the impact of infection. CONCLUSION Perioperative kidney graft infection influenced graft funtion in the early and late periods post-transplantation.
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Affiliation(s)
- M Zukowski
- Department of Anaesthesiology and Intensive Care, Pomeranian Medical University, Szczecin, Poland.
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Abstract
BACKGROUND Single-port laparoscopic surgery has been described for various colorectal conditions. Here, we report the first 4 single-port laparoscopic sigmoid colostomies for fecal diversion. METHODS A 1.5-cm-round incision was made on the skin at a previously marked colostomy site. A wound retractor was inserted and an access platform with four 5-mm trocars was attached to the wound retractor. The sigmoid colon was mobilized using electrocautery, laparoscopic scissors, or an advanced bipolar device. A standard Brooke colostomy was created through the initial skin incision. RESULTS Four elective single-port laparoscopic diverting colostomies were performed. Indications included obstructing colon and rectal cancers and intractable Crohn's proctitis. The average operative time was 73 minutes (range, 53-105), and blood loss was minimal (<50 mL). There were no intraoperative complications. Three of 4 patients received oral analgesia, and one patient received patient-controlled intravenous analgesia postoperatively. The average time to passage of flatus was 1 day. Diet was advanced either on the day of surgery or on postoperative day 1. The length of hospital stay ranged from 0 to 15 days. CONCLUSION Single-port laparoscopic sigmoid colostomy is an effective technique that allows full intra-abdominal visualization and colonic mobilization while eliminating the need for additional skin incisions other than the colostomy site itself.
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Basso MS, Subramaniam P, Tredger M, Verma A, Heaton N, Rela M, Mieli-Vergani G, Dhawan A. Sirolimus as renal and immunological rescue agent in pediatric liver transplant recipients. Pediatr Transplant 2011; 15:722-7. [PMID: 22004546 DOI: 10.1111/j.1399-3046.2011.01560.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
CNI have improved the outcome of LT. However, their inherent potential to nephrotoxic and sometimes-inadequate immunosuppressive effect has lead to the usage of newer drugs like SRL. Aim of this study was to review children who received SRL. Thirty-seven (20 women) children post-LT, median age 10.4 yr (0.8-17.4) with a minimum follow-up of six months comprised the study group. Indications for SRL were biopsy-proven resistant acute allograft rejection (n = 12), early CR (n = 12), and CNI-induced nephropathy with MMF intolerance (n = 11). In two patients, the indication was the recurrence of BSEP disease in the allograft. In patients with acute rejection, AST normalized in 10/12 patients. In patients with CR, AST normalized in 6/12 patients. Those with renal impairment showed improvement in their creatinine levels from a mean baseline of 99-56.7 μm (p = 0.03) and their mean cystatin C was 1.02 after SRL. Side effects leading to discontinuation of SRL were seen in three patients. SRL was effective in rescuing patients with acute and chronic allograft rejection and improving renal function in CNI-induced nephropathy group.
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Affiliation(s)
- Maria-Sole Basso
- Paediatric Liver, GI and Nutrition Centre, Institute of Liver Studies, King's College Hospital, London, UK
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Boubaker K, Harzallah A, Ounissi M, Becha M, Guergueh T, Hedri H, Kaaroud H, Abderrahim E, Ben Abdellah T, Kheder A. Rehospitalization after kidney transplantation during the first year: length, causes and relationship with long-term patient and graft survival. Transplant Proc 2011; 43:1742-6. [PMID: 21693269 DOI: 10.1016/j.transproceed.2011.01.178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is a wide interest in epidemiologic studies assessing different causes of post-kidney transplantation rehospitalization. However, there is a paucity of knowledge on the long-term survival and graft function of rehospitalized kidney transplant recipients during the first year. Knowledge of posttransplant rehospitalization causes may help guide the preventive program at the first year. In our study, we assess causes for hospitalization and investigate the long-term patient and graft survival after non-fatal rehospitalization in kidney recipients during the first year. MATERIALS AND METHODS We retrospectively studied the medical histories of 419 kidney transplant recipients whose operations were performed between 1986 and 2009 at Charles Nicolle Hospital, in Tunis, Tunisia. Among these patients, a total of 296 posttransplant rehospitalizations of kidney transplant recipients during the first year occurring in 191 (45.5%) patients were assessed. Clinical characteristics of the patients, including gender, age, reason for kidney failure, weight, height, blood group, length of pretransplant dialysis, immunosuppressive regimen, postoperative complications, the length of hospital stay, transplantation-admission interval, causes of rehospitalizations, graft loss, and mortality rate were reviewed. For donors, these demographics included age, gender, blood group, type of donor (deceased or living), and relationship to the recipient. Because rehospitalizations are possible for more than one cause, the sum of frequencies of rehospitalization causes is more than 100%. RESULTS There was 1 rehospitalization in 121 patients, 2 rehospitalizations in 47 patients, 3 rehospitalizations in 15 patients, 4 rehospitalizations in 5 patients, 5 rehospitalizations in 2 patients and 6 rehospitalizations in 1 patient. Rehospitalization was more frequent for diabetic patients without significant association. The causes of rehospitalization were infection in 221 cases (55.5%), renal dysfunction in 106 cases (26%), cardiovascular event in 10 cases (2.4%), and diabetic ketoacidosis in 11 cases (2.7%). The length of hospital stay was 22.5 ± 29.6 days, 20.15 ± 22.16 days, 25 ± 30 days and 23.4 ± 27.5 days, respectively, in the first, second, third, and fifth rehospitalizations. Median hospital stay for all rehospitalizations was between 14 and 16 days. The risk factors of rehospitalization were: use of mycophenolate mofetile (P = .0072), use of cyclosporine (P = .0073), and cytomegalovirus infection (P < .001). There was no significant correlation between rehospitalization and either lost of graft and death. CONCLUSIONS During the first year after kidney transplantation, rehospitalization was especially required because of infections and renal dysfunction. The risk factors of rehospitalization were cadaveric graft, use of mycophenolate mofetil, use of cyclosporine, and cytomegalovirus infection. To prevent and minimize rehospitalizations during the first year, a specific preventive program based on infection prevention and graft function monitoring should be established.
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Affiliation(s)
- K Boubaker
- Internal Medicine Department, Charles Nicolle Hospital, Tunis, Tunisia.
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Abstract
Cutaneous squamous cell carcinoma (SCC) is the second most common human cancer and can behave aggressively. Mohs micrographic surgery offers the highest cure rates for high-risk SCCs and is particularly useful for SCCs on challenging anatomic sites.
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Affiliation(s)
- Daniel Belkin
- Department of Dermatology, Weill Cornell Medical College, 1305 York Avenue, New York, NY 10021, USA
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Bone Healing After Secondary Surgery on Hand Allografts Under Sirolimus-Based Maintenance Immunosuppression. Ann Plast Surg 2011; 66:667-9. [DOI: 10.1097/sap.0b013e318212686b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laparoscopic Incisional Hernia Repair After Solid-Organ Transplantation. Transplant Proc 2011; 43:1783-9. [DOI: 10.1016/j.transproceed.2011.03.082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/29/2011] [Indexed: 01/10/2023]
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Berglund D, Bengtsson M, Biglarnia A, Berglund E, Yamamoto S, von Zur-Mühlen B, Lorant T, Tufveson G. Screening of mortality in transplant patients using an assay for immune function. Transpl Immunol 2011; 24:246-50. [PMID: 21232600 DOI: 10.1016/j.trim.2010.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 12/29/2010] [Accepted: 12/31/2010] [Indexed: 12/28/2022]
Abstract
BACKGROUND So far, the ImmuKnow Immune Cell Function Assay (Cylex, Inc., Columbia, MD, USA) has been used to assess risks of infection and rejection in transplant patients. We hypothesized that the ImmuKnow assay might be used for mortality screening in transplant patients overall. METHODS In the period of February 2007 to December 2009, at the Uppsala University Hospital, 362 patients who received either kidney, kidney+pancreas, kidney+islet cells, liver or liver+kidney allografts were randomly screened using the ImmuKnow assay. All causes of mortality were compared between two groups: patients with at least one ImmuKnow assay below 175ng/mL and patients with all ImmuKnow assays from 175ng/mL and above. Subsequently, the frequency of rejection within thirty days of the ImmuKnow assay was compared between these two groups. RESULTS The study included 1031 ImmuKnow assays obtained from the 362 patients. A total of 111 patients had at least one ImmuKnow below 175ng/mL and 251 patients had all their ImmuKnow assays from 175ng/mL and above. By January 31st 2010, 16 of 111 patients (14.4%) with at least one ImmuKnow assay below 175ng/mL were deceased, compared to 13 of 251 patients (5.2%) with all ImmuKnow assays from 175ng/mL and above (p=0.0053, Fisher's exact test). There was no difference in the frequency of rejection between the two groups (19.8% versus 17.5%, p=0.66). CONCLUSIONS In addition to assessing relative risks of infection and rejection in transplant patients, the ImmuKnow assay may be used to identify patients with increased risk of short-term mortality. Transplant patients being highly overimmunosuppressed as assessed by the ImmuKnow assay do not seem to have a lower risk of short-term rejection.
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Affiliation(s)
- David Berglund
- Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University, Sweden
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Pignot G, Lebret T, Chekulaev D, Peyromaure M, Saighi D, Flam T, Amsellem-Ouazana D, Debre B, Zerbib M. [Healing and targeted therapies: Management in perioperative period?]. Prog Urol 2010; 21:166-72. [PMID: 21354033 DOI: 10.1016/j.purol.2010.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/28/2010] [Accepted: 09/29/2010] [Indexed: 01/16/2023]
Abstract
INTRODUCTION In the era of new-targeted therapies and neoadjuvant strategies, this article highlights the role of angiogenesis in the process of physiological wound healing with a review of literature about parietal complications under anti-angiogenic therapies. METHODS Research on Medline was carried out using the terms renal cell carcinoma, angiogenesis, wound healing, targeted therapies, and complications. RESULTS The frequency of these complications varies between 5 and 50% in recent series. These results depend on half-lives of each drug and perioperative management (before and after surgical procedure). CONCLUSION In the absence of current recommendations, it is advised to stop bevacizumab at least five weeks before a surgical intervention and to take it back 4 weeks later. For the tyrosine kinase inhibitors, the treatment can be stopped 24-48 hours before the surgery and taken back 3-4 weeks later. Finally, for the mTOR inhibitors, it is advised to stop the treatment 7-10 days before and to take back it at least 3 weeks later.
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Affiliation(s)
- G Pignot
- Service d'urologie, hôpital Cochin, université René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Dantal J, Berthoux F, Moal MC, Rostaing L, Legendre C, Genin R, Toupance O, Moulin B, Merville P, Rerolle JP, Bayle F, Westeel PF, Glotz D, Kossari N, Lefrançois N, Charpentier B, Quéré S, Di Giambattista F, Cassuto E. Efficacy and safety of de novo or early everolimus with low cyclosporine in deceased-donor kidney transplant recipients at specified risk of delayed graft function: 12-month results of a randomized, multicenter trial. Transpl Int 2010; 23:1084-93. [PMID: 20500493 DOI: 10.1111/j.1432-2277.2010.01094.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Immediate or early use of proliferation signal inhibitor (PSI)/mammalian target of rapamycin (mTOR) inhibitor therapy can avoid high exposure to calcineurin inhibitors but concerns exist relating to the risk of delayed graft function (DGF) and impaired wound healing with the mTOR sirolimus. CALLISTO was a 12-month, prospective, multicenter, open-label study. Deceased-donor kidney transplant patients at protocol-specified risk of DGF were randomized to start everolimus on day 1 (immediate everolimus, IE; n = 65) or week 5 (delayed everolimus, DE; n = 74). Incidence of the primary endpoint (biopsy-proven acute rejection, BPAR; graft loss, death, DGF, wound healing complications related to transplant surgery or loss to follow-up) was 64.6% and 66.2% in the IE and DE groups, respectively, at month 12 (P = 0.860). The overall incidence of BPAR was 20.1%. Median estimated glomerular filtration rate was 48 ml/min/1.73 m(2) and 49 ml/min/1.73 m(2) in the IE and DE groups, respectively, at month 12. DGF and wound healing complications were similar between groups. Adverse events led to study drug discontinuation in 17 IE patients (26.2%) and 28 DE patients (37.8%) (NS). In conclusion, introduction of everolimus immediately or early posttransplant in DGF-risk patients is associated with good efficacy, renal function and safety profile. There seems no benefit in delaying initiation of everolimus.
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Affiliation(s)
- Jacques Dantal
- Service de Néphrologie et Transplantation Rénale, Hôpital Hôtel Dieu, Nantes, France.
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