1
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Li L, Fu R. Advances in research on renal injury in paroxysmal nocturnal hemoglobinuria. J Investig Med 2024:10815589241254046. [PMID: 38715220 DOI: 10.1177/10815589241254046] [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: 08/30/2024]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic stem cell disease. Clinical manifestations include intravascular hemolysis, renal dysfunction, fatigue, jaundice, pulmonary hypertension, and so on. Renal injury, as a clinical feature of PNH, is difficult to diagnose and is one of the causes of death in patients with PNH. This article reviews the progress in research on PNH combined with renal injury to improve clinicians' understanding of renal injury in PNH patients, define and judge staging in a timely and accurate manner, enable patients to receive timely and appropriate treatment and reduce mortality.
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Affiliation(s)
- Liyan Li
- Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin, P.R. China
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Rong Fu
- Tianjin Key Laboratory of Bone Marrow Failure and Malignant Hemopoietic Clone Control, Tianjin, P.R. China
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, P.R. China
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2
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Novacescu D, Latcu SC, Raica M, Baderca F, Dumitru CS, Daminescu L, Bardan R, Dema V, Croitor A, Cut TG, Cumpanas AA. Surgical Strategies for Renal Transplantation: A Pictorial Essay. J Clin Med 2024; 13:4188. [PMID: 39064228 PMCID: PMC11278135 DOI: 10.3390/jcm13144188] [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: 05/14/2024] [Revised: 07/13/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
This pictorial essay aims to navigate through the complexities and challenges of renal transplantation (RT), by weaving together visual imagery with clinical insights within a comprehensive illustrative surgical guide. Herein, we provide a detailed visual exploration of the intricate anatomy and surgical processes necessary for both renal graft retrieval from the donor and also for an adequate implantation in the recipient. Regarding graft retrieval, after reviewing the relevant retroperitoneal surgical anatomy, and donor nephrectomy techniques, graft preservation and optimal backbench graft dissection principles were meticulously analyzed. Thereafter, the recipient surgical strategy for graft implantation was addressed, focusing on preoperative preparations, the site of implantation selection, exposure, operative bed dissection, graft revascularization, and urinary tract reconstruction. Careful donor and recipient selection, meticulous surgical execution, and rigorous postoperative management clearly hold a pivotal role in optimizing patient outcomes. Fostering a deeper understanding of the surgical nuances and clinical management practices that contribute to successful results post-RT, we hope to provide a useful practical tool for clinicians about to embark on the treacherous road of RT surgery. Innovative technologies and surgical practices that have already significantly improved the safety and effectiveness of RT stand testament to the importance of further scientific inquiry, conceptual developments, and clinical integration. Moving forward, it is essential that the medical community continues to refine these strategies and advocate for equitable access to transplantation, ensuring that advancements in the field translate into real-world benefits for all patients grappling with ESRD. The collaborative efforts of multidisciplinary teams are essential in addressing the complex clinical challenges associated with RT, with the ultimate goal of improving patient survival, enhancing graft longevity, and reducing healthcare disparities.
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Affiliation(s)
- Dorin Novacescu
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (D.N.); (M.R.); (F.B.); (C.-S.D.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Silviu Constantin Latcu
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.D.); (A.C.)
- Department of Urology, “Pius Brinzeu” Timisoara County Emergency Hospital, Liviu Rebreanu Boulevard, Nr. 156, 300723 Timisoara, Romania; (L.D.); (R.B.); (A.A.C.)
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Marius Raica
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (D.N.); (M.R.); (F.B.); (C.-S.D.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Flavia Baderca
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (D.N.); (M.R.); (F.B.); (C.-S.D.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Cristina-Stefania Dumitru
- Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania; (D.N.); (M.R.); (F.B.); (C.-S.D.)
- Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Liviu Daminescu
- Department of Urology, “Pius Brinzeu” Timisoara County Emergency Hospital, Liviu Rebreanu Boulevard, Nr. 156, 300723 Timisoara, Romania; (L.D.); (R.B.); (A.A.C.)
| | - Razvan Bardan
- Department of Urology, “Pius Brinzeu” Timisoara County Emergency Hospital, Liviu Rebreanu Boulevard, Nr. 156, 300723 Timisoara, Romania; (L.D.); (R.B.); (A.A.C.)
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Vlad Dema
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.D.); (A.C.)
- Department of Urology, “Pius Brinzeu” Timisoara County Emergency Hospital, Liviu Rebreanu Boulevard, Nr. 156, 300723 Timisoara, Romania; (L.D.); (R.B.); (A.A.C.)
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alexei Croitor
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania; (V.D.); (A.C.)
- Department of Urology, “Pius Brinzeu” Timisoara County Emergency Hospital, Liviu Rebreanu Boulevard, Nr. 156, 300723 Timisoara, Romania; (L.D.); (R.B.); (A.A.C.)
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania;
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alin Adrian Cumpanas
- Department of Urology, “Pius Brinzeu” Timisoara County Emergency Hospital, Liviu Rebreanu Boulevard, Nr. 156, 300723 Timisoara, Romania; (L.D.); (R.B.); (A.A.C.)
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
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Vigués F, Etcheverry B, Perez Reggeti JI, Gaya JM, Territo A, Gallioli A, Berquin C, Basile G, Suárez JF, Fiol M, Buisan O, Riera L, Prudhomme T, Doumerc N, Pecoraro A, Breda A. Orthotopic Robot-assisted Kidney Transplantation: Surgical Technique and Preliminary Results. Eur Urol 2024; 85:556-564. [PMID: 38627151 DOI: 10.1016/j.eururo.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/05/2024] [Accepted: 03/28/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Orthotopic kidney transplantation (KT) has been proposed as an option for patients ineligible for heterotopic KT. In this scenario, orthotopic robot-assisted KT (oRAKT) represents a novel, minimally invasive alternative to the open approach. Here we describe the largest oRAKT series of patients, with a focus on the surgical technique, perioperative surgical outcomes, and functional results. METHODS We queried prospectively maintained databases from three referral centers to identify patients who underwent oRAKT and evaluated surgical and functional outcomes. KEY FINDINGS AND LIMITATIONS Overall, 16 oRAKT procedures were performed between January 2020 and August 2023. These involved four donors after cardiovascular death, five donors after brain death, and seven living donors. All oRAKT procedures were carried out in the left renal fossa. The indication for oRAKT was extensive calcification of the external iliac vessels (100%), frequently associated with prior KT (31%). The median operative time was 295 min (interquartile range [IQR] 268-360) and the median rewarming time 48 min (IQR 40-54). Conversion to open surgery occurred in two cases (12%), and delayed graft function was observed in two cases (12%). Postoperative complications occurred in 11 patients (69%) and three (18%) experienced Clavien-Dindo grade >II complications. At median follow-up of 9 mo (IQR 7-17), 14 patients had a functioning graft and median creatinine of 1.49 mg/dl (IQR 1.36-1.72). CONCLUSIONS AND CLINICAL IMPLICATIONS Although oRAKT is a challenging procedure, it represents a feasible option for individuals ineligible for heterotopic KT and yields favorable perioperative and mid-term functional outcomes. PATIENT SUMMARY We evaluated outcomes of orthotopic robot-assisted kidney transplantation (KT), in which the native kidney is removed and the donor kidney is transplanted into its place, in patients who are not eligible for heterotopic KT, in which the native kidney is left in place and the donor kidney is transplanted into a new location. We found that robot-assisted surgery is a safe and feasible alternative to traditional open surgery for orthotopic KT.
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Affiliation(s)
- Francesc Vigués
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Begoña Etcheverry
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - José I Perez Reggeti
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Camille Berquin
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain; Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain; Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - José F Suárez
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Maria Fiol
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Oscar Buisan
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Lluís Riera
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Thomas Prudhomme
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Alessio Pecoraro
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
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Territo A, Selvi İ, Malçok A, Boissier R, Campi R, Prudhomme T, Pecoraro A, Piana A, Lopez-Abad A, Bañuelos Marco B, Breda A, Dönmez Mİ. Graft survival and postoperative complications following orthotopic renal transplantation. Clin Transplant 2024; 38:e15220. [PMID: 38078675 DOI: 10.1111/ctr.15220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/30/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
The iliac fossa is the most commonly used site to place the graft in renal transplantation in adults. However, iliac fossa may not be used in various conditions. Thus, orthotopic renal transplantation becomes a viable alternative for these selected patients. Given the technically challenging surgery and limited number of patients, data on the long-term outcomes on this regard are scarce. This narrative review serves as an update on the clinical outcomes after orthotopic renal transplantation, focusing on overall recipient survival and renal graft survival, as well as postoperative complications. We found that studies to date showed a comparable survival rate in both recipients and renal grafts in the postoperative follow-up period after orthotopic renal transplantation with a lower complication rate compared to the published data on heterotopic renal transplantation. The results of our review may encourage transplant centers to reevaluate their policies to consider orthotopic renal transplantation as an alternative technique in cases where heterotopic kidney transplantation is not possible.
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Affiliation(s)
- Angelo Territo
- Uro-Oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma, University of Barcelona, Barcelona, Spain
| | - İsmail Selvi
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, İstanbul, Turkey
| | - Aydan Malçok
- Department of Biostatistics, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, La Conception University Hospital, Marseille, France
| | - Riccardo Campi
- Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | - Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - Alessio Pecoraro
- Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital University of Turin, Orbassano, Turin, Italy
| | - Alicia Lopez-Abad
- Department of Urology, Virgen de la Arrixaca Hospital, Murcia, Spain
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - M İrfan Dönmez
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, İstanbul, Turkey
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Ohyama T, Sasaki H, Minamisono K, Nishida S, Iwami D. Orthotopic kidney transplantation from a living renal donor after interventional therapy for bilateral arteriosclerosis obliterans of the iliac arteries: A case report and literature review. IJU Case Rep 2023; 6:428-432. [PMID: 37928296 PMCID: PMC10622225 DOI: 10.1002/iju5.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Orthotopic kidney transplantation is an option when heterotopic kidney transplantation into the iliac fossa is inappropriate. We report a case of orthotopic kidney transplantation following stenting of both external iliac arteries to treat arteriosclerosis obliterans. Case presentation A 56-year-old woman on hemodialysis for end-stage kidney disease underwent living-donor kidney transplantation. Desensitization therapy was administered because of her history of sensitization by pregnancy. Stents had been placed previously in both external iliac arteries. The left kidney was removed via an oblique lumbar incision. The two graft arteries were conjoined and anastomosed to the native renal artery end-to-end. The urinary tract was reconstructed by uretero-ureterostomy with ureteral stent placement. Renal function improved promptly after surgery. Conclusion Preoperative imaging of vascular anatomy is important for successful orthotopic kidney transplantation in patients who have previously undergone stenting of both external iliac arteries for arteriosclerosis obliterans.
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Affiliation(s)
- Takehiro Ohyama
- Division of Renal Surgery and Transplantation, Department of UrologyJichi Medical University HospitalTochigiJapan
| | - Hajime Sasaki
- Division of Renal Surgery and Transplantation, Department of UrologyJichi Medical University HospitalTochigiJapan
| | - Kyoko Minamisono
- Division of Renal Surgery and Transplantation, Department of UrologyJichi Medical University HospitalTochigiJapan
| | - Sho Nishida
- Division of Renal Surgery and Transplantation, Department of UrologyJichi Medical University HospitalTochigiJapan
| | - Daiki Iwami
- Division of Renal Surgery and Transplantation, Department of UrologyJichi Medical University HospitalTochigiJapan
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Dixon W, Sheetz K, Feng S. Kidney transplantation in a patient with anomalous iliofemoral vasculature. Am J Transplant 2023; 23:1641-1643. [PMID: 37778869 DOI: 10.1016/j.ajt.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Wesley Dixon
- Division of Transplant, Department of Surgery, University of California, San Francisco, California, USA
| | - Kyle Sheetz
- Division of Transplant, Department of Surgery, University of California, San Francisco, California, USA
| | - Sandy Feng
- Division of Transplant, Department of Surgery, University of California, San Francisco, California, USA.
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Kidney Autotransplantation and Orthotopic Kidney Transplantation: Two Different Approaches for Complex Cases. Adv Urol 2022; 2022:9299397. [PMID: 35968202 PMCID: PMC9366201 DOI: 10.1155/2022/9299397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/14/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Transplantation surgery teams often have to face complex cases. In certain circumstances, such as occlusion of the iliac vessels or prior pelvic surgery, heterotopic kidney transplantation may not be feasible and orthotopic kidney transplantation (OKT) could be a good alternative. Kidney autotransplantation (KAT) has been described as a potential treatment for complex renovascular, ureteral, or neoplastic conditions. There are scarce data regarding the complications and outcomes of these procedures; therefore, we present our experience. Materials and Methods. We retrospectively analysed the medical records of both 21 patients who had received OKT and 19 patients who underwent KAT between 1993 and 2020. We collected demographic features and data regarding surgical technique, complications, and graft outcomes. Kidney graft survival was calculated using Kaplan–Meier survival analysis. Results. Regarding OKT, in 15 (71.43%) cases, it was the first kidney transplantation. The most common indication was the unsuitable iliac region due to vascular abnormalities (57.14%). The early postoperative complication rate was high (66.67%), with 23.81% of Clavien grade 3b complications. During the follow-up period (mean 5.76 -SD 6.15- years), we detected 9 (42.85%) graft losses. At 1 year, the survival rate was 84.9%. Concerning KAT, the most frequent indication was ureteral pathology (52.63%), followed by vascular lesions (42.11%). The overall early complication rate was 42.11%. During the follow-up period (mean of 4.47 years), 4 (15.79%) graft losses were reported. Conclusions. Although OKT and KAT have high complication rates, these techniques can be considered as two valuable approaches for complex cases, in the absence of other therapeutic options.
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Castillo-Delgado CA, García-Perdomo HA, Musquera M, Alcaraz A. Orthotopic kidney transplantation survival and complications: systematic review and meta-analysis. Arab J Urol 2022; 20:212-218. [PMID: 36353475 PMCID: PMC9639495 DOI: 10.1080/2090598x.2022.2090133] [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: 01/31/2022] [Accepted: 06/13/2022] [Indexed: 11/02/2022] Open
Abstract
Purpose To determine graft and patient survival and adverse events in patients who undergo orthotopic kidney transplantation. Methods We performed a systematic review and meta-analysis. We search in Medline, Embase, and Central from inception to nowadays. We included observational studies with patients who undergo orthotopic kidney transplantation. The primary outcomes were overall patient and graft survival. We pooled the information in a frequency meta-analysis with a 95% CI. We analyzed bias with the STROBE statement. Results Of the 106 papers initially retrieved, four met the inclusion criteria. Vascular and urinary tract complications were reported in 19% and 15%, respectively. The overall patient survival was 92% 95%CI (88% to 95%), I2 = 0%, and the overall graft survival was 88% 95 CI (83% to 91%), I2 = 0%. Conclusion Our analysis showed a high survival rate in patients and kidney grafts after orthotopic kidney transplantation, with a similar complication rate compared to a heterotopic kidney transplant.
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Affiliation(s)
- Carlos Alfredo Castillo-Delgado
- Division of Transplant Surgery, Department of General Surgery, Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Herney Andrés García-Perdomo
- Division of Urology/Urooncology, Department of Surgery, UROGIV Research Group, Universidad del Valle, Cali, Colombia
| | - Mireia Musquera
- Division of Kidney Transplant Surgery, Department of Urology, Hospital Clinic – University of Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Division of Kidney Transplant Surgery, Department of Urology, Hospital Clinic – University of Barcelona, Barcelona, Spain
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Sageshima J, Chandar J, Chen LJ, Shah R, Al Nuss A, Vincenzi P, Morsi M, Figueiro J, Vianna R, Ciancio G, Burke GW. How to Deal With Kidney Retransplantation-Second, Third, Fourth, and Beyond. Transplantation 2022; 106:709-721. [PMID: 34310100 DOI: 10.1097/tp.0000000000003888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Kidney transplantation is the best health option for patients with end-stage kidney disease. Ideally, a kidney transplant would last for the lifetime of each recipient. However, depending on the age of the recipient and details of the kidney transplant, there may be a need for a second, third, fourth, or even more kidney transplants. In this overview, the outcome of multiple kidney transplants for an individual is presented. Key issues include surgical approach and immunologic concerns. Included in the surgical approach is an analysis of transplant nephrectomy, with indications, timing, and immunologic impact. Allograft thrombosis, whether related to donor or recipient factors merits investigation to prevent it from happening again. Other posttransplant events such as rejection, viral illness (polyomavirus hominis type I), recurrent disease (focal segmental glomerulosclerosis), and posttransplant lymphoproliferative disease may lead to the need for retransplantation. The pediatric recipient is especially likely to need a subsequent kidney transplant. Finally, noncompliance/nonadherence can affect both adults and children. Innovative approaches may reduce the need for retransplantation in the future.
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Affiliation(s)
- Junichiro Sageshima
- Division of Transplant Surgery, Department of Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Jayanthi Chandar
- Division of Pediatric Kidney Transplantation, Department of Pediatrics, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Linda J Chen
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Rushi Shah
- Surgical Transplant Fellow, Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Ammar Al Nuss
- Surgical Transplant Fellow, Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Paolo Vincenzi
- Surgical Transplant Fellow, Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Mahmoud Morsi
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Jose Figueiro
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Rodrigo Vianna
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
- Division of Liver and GI Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Gaetano Ciancio
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
| | - George W Burke
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL
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10
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Zhang P, Han XW, Zhang X, Zhu XH, Li T, Li YS, Chen YH, Li G, Han LX, Zhang RJ. Laparoscopic Orthotopic Kidney Transplantation in Swine: A Novel Vascular Prop Device for Venous Anastomoses. Front Surg 2021; 8:708449. [PMID: 34513914 PMCID: PMC8427757 DOI: 10.3389/fsurg.2021.708449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: To investigate the safety and efficacy of a vascular prop device for laparoscopic orthotopic kidney transplantation (LOKT) in swine. Material and Methods: Twenty swine were randomly divided into two groups. A vascular prop device was used in the observation (VP) group, and the vein beltization technique was used in the control (VB) group. The right kidney, as a donor graft, was laparoscopically transplanted to the location of the left kidney after a left nephrectomy. Data on the operative time, venous anastomotic time, vein stenosis, etc., and the survival of the swine in the two groups were recorded. Results: The mean transplant operative time, the mean cold ischemia time, and the venous anastomotic times in the VP group were significantly shorter than those in the VB group. Seven swine in the VP group and three swine in the VB group survived for 7 days. Autopsy results showed the occurrence of one artery stenosis and one vein stenosis in the VP group and one artery stenosis and five vein stenoses in the VB group. The median survival time was 6.25 days for the swine in the VP group and 4.40 days for those in the VB group. Conclusions: The vascular prop device is safe and feasible for LOKT in swine and may accelerate venous anastomosis and ensure the quality of venous anastomotic stoma.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Wu Han
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xu-Hui Zhu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Tao Li
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan-Sheng Li
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuan-Hao Chen
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Gao Li
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Long-Xi Han
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rong-Jie Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Kinoshita Y, Iwami D, Fujimura T, Kume H, Yokoo T, Kobayashi E. Techniques of orthotopic renal transplantation in pigs. One donor to two recipients via inverted grafting. Acta Cir Bras 2021; 36:e360208. [PMID: 33624724 PMCID: PMC7902078 DOI: 10.1590/acb360208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/24/2020] [Accepted: 01/23/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Although transplanting two kidneys from a single donor to two recipients has some advantages, the right and left kidneys are not anatomically identical; thus, a surgical procedure considering the anatomical features of the donor kidneys is needed when transplanting them into the opposite renal fossae. Based on vast experience, the surgical details of pig orthotopic kidney transplantation from one donor to two recipients was reported. METHODS When the right kidney was transplanted to the left renal fossa, the graft was inverted upside down, not backwards, thus ensuring that the anteroposterior relationship of the renal vessels was maintained and anatomically natural vascular anastomosis could be performed. RESULTS Using this technique, we could have developed a pig experimental model that is safe and has a high success rate, even for researchers in the middle of their training. This technique of inverting the graft upside down was reported in human kidney transplantation to make vascular anastomosis easier. CONCLUSIONS In pig orthotopic kidney transplantation from one donor to two recipients, an anatomically natural vascular anastomosis could be performed via inverted grafting when the right kidney was transplanted into the left renal fossa.
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Affiliation(s)
- Yoshitaka Kinoshita
- MD. Jichi Medical University – Department of Urology – Division of
Renal Surgery and Transplantation – Tochigi, Japan. Jichi Medical University –
Department of Urology – Division of Urology – Tochigi, Japan
| | - Daiki Iwami
- MD, PhD. Jichi Medical University – Department of Urology – Division
of Renal Surgery and Transplantation – Tochigi, Japan
| | - Tetsuya Fujimura
- .MD, PhD. Jichi Medical University – Department of Urology –
Division of Urology – Tochigi, Japan
| | - Haruki Kume
- MD, PhD. The University of Tokyo – Graduate School of Medicine –
Department of Urology – Tokyo, Japan
| | - Takashi Yokoo
- MD, PhD. The Jikei University School of Medicine – Department of
Internal Medicine – Division of Nephrology and Hypertension – Tokyo, Japan
| | - Eiji Kobayashi
- MD, PhD. The Jikei University School of Medicine – Department of
Kidney Regenerative Medicine; Keio University School of Medicine – Department of
Organ Fabrication – Tokyo, Japan
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