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Segaran A, Grant A, Heer M. Renal autotransplant for transitional cell carcinoma in a congenital solitary pelvic kidney. ANZ J Surg 2023; 93:752-753. [PMID: 35972733 DOI: 10.1111/ans.17989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Anjelee Segaran
- Newcastle Transplant Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Alexander Grant
- Department of Urology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Munish Heer
- Newcastle Transplant Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
- Hunter Transplant Research Foundation, Newcastle Transplant Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
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Contarini E, Takagi K, Kimenai HJAN, Ijzermans JNM, Furian L, Rigotti P, Minnee RC. Kidney Autotransplantation for Renal Artery Aneurysm: Case Series and a Systematic Review. Ann Vasc Surg 2021; 77:349.e5-349.e18. [PMID: 34437957 DOI: 10.1016/j.avsg.2021.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/10/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Renal artery aneurysm (RAA) is a rare vascular disease. Kidney autotransplantation (KAT) is the treatment option when endovascular approach is not available. However, the evidence on KAT for RAA is mostly limited to small case series or reports. Here, we describe our 2 center experience of KAT for RAA, and provide the results of our systematic literature review to evaluate the outcomes. METHODS A retrospective 2 center study was conducted in patients undergoing KAT for RAA between 2010 and 2018. Moreover, a systematic review was performed on medical databases to evaluate the outcomes of KAT for RAA. RESULTS Nine patients were surgically treated at our institutions: eight with laparoscopic nephrectomy (LN), and 1 with open followed heterotopic KAT. All RAAs were ex-vivo reconstructed, and in 3 cases a vein graft was used for reconstruction. There were 2 postoperative major complications including 1 graft loss. In the systematic review, 102 studies with 355 patients were included. In 35 patients (9.9%) a minimal invasive approach was performed. The incidence of postoperative major complications and graft loss was 9.4% and 4.1%. CONCLUSIONS Our experiences showed that laparoscopic approach for nephrectomy followed heterotopic KAT was feasible with good postoperative outcomes. KAT is an effective treatment for RAA when endovascular approach is not feasible for interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.
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Affiliation(s)
- Emanuele Contarini
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Kosei Takagi
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Hendrikus J A N Kimenai
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Paolo Rigotti
- Kidney and Pancreas Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Robert C Minnee
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Sprott P, Hibberd AD, Heer MK, Trevillian PR, Clark DA, Johnson DW, Oldmeadow C, Chiu S, Attia JR. Assessment of Restored Kidney Transplantation Including the Use of Wider Criteria for Accepting Renal Donors After Cancer Excision. Transplant Direct 2019; 5:e498. [PMID: 31773051 PMCID: PMC6831121 DOI: 10.1097/txd.0000000000000946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/26/2022] Open
Abstract
The transplantation of kidneys after cancer excision (restored kidney transplantation, RKT) warrants further evaluation as a source of kidneys for transplantation. We determined whether larger cancers can be safely transplanted, the risks of adverse events from RKT, and whether RKT confers a survival advantage for patients waiting for transplantation. METHODS In a retrospective cohort study, 23 dialysis patients awaiting transplant underwent RKT at John Hunter Hospital, Australia between 2008 and 2015. Patients were >60 years old and accepted onto the National Organ Matching Service. This RKT Group was divided into donor renal cancers ≤30 mm and >30-≤50 mm. Adverse event profiles for RKT recipients were compared with 22 standard live donor recipients using logistic regression analyses. Recipient and transplant survivals for RKT were compared with 2050 controls from Australian New Zealand Dialysis Transplant Registry using Cox regression models. To increase statistical power for survival analyses, data from 25 RKT recipients from Princess Alexandra Hospital, Brisbane were added, thus creating 48 RKT recipients. RESULTS There were no significant differences in mortality, transplant failure nor AEs between the 2 cancer Groups. RKT increased the risks of Adverse event profiles (odds ratio: 6.48 [2.92-15.44]; P < 0.001). RKT reduced mortality risk by 30% (hazard ratio [HR]: 0.70 [0.36-1.07]; P = 0.299) compared with those continuing on the transplant list who may or may not be transplanted. RKT significantly reduced mortality risk for those remaining on dialysis (HR: 2.86 [1.43-5.72]; P = 0.003). Transplant survival for RKT was reduced compared with control deceased donor (HR: 0.42 [0.21-0.83]; P = 0.013) and live donor transplants (HR: 0.33 [0.02-0.86]; P =0.023). CONCLUSIONS The use of larger carefully selected cancer-resected kidneys for transplantation appears safe and effective. RKT confers a possible survival advantage compared with waiting for transplantation, an increased survival compared with those remaining on dialysis but reduced transplant survival.
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Affiliation(s)
- Philip Sprott
- Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Adrian D. Hibberd
- Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Munish K. Heer
- Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Paul R. Trevillian
- Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - David A. Clark
- Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - David W. Johnson
- Renal Queensland Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Christopher Oldmeadow
- Clinical Trials Support Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Simon Chiu
- Clinical Trials Support Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - John R. Attia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Clinical Trials Support Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia
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Moghadamyeghaneh Z, Hanna MH, Fazlalizadeh R, Obi Y, Foster CE, Stamos MJ, Ichii H. A Nationwide Analysis of Kidney Autotransplantation. Am Surg 2017. [PMID: 28228203 DOI: 10.1177/000313481708300216] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There are limited data regarding outcomes of patients underwent kidney autotransplantation. This study aims to investigate outcomes of such patients. The nationwide inpatient sample database was used to identify patients underwent kidney autotransplantation during 2002 to 2012. Multivariate analyses using logistic regression were performed to investigate morbidity predictors. A total of 817 patients underwent kidney autotransplantation from 2002 to 2012. The most common indication of surgery was renal artery pathology (22.7%) followed by ureter pathology (17%). Overall, 97.7 per cent of operations were performed in urban teaching hospitals. The number of procedures from 2008 to 2012 were significantly higher compared with the number of them from 2002 to 2007 (473 vs 345, P < 0.01). The overall mortality and morbidity of patients were 1.3 and 46.2 per cent, respectively. The most common postoperative complications were transplanted kidney failure (10.7%) followed by hemorrhagic complications (9.7%). Obesity [adjusted odds ratio (AOR): 9.62, P < 0.01], fluid and electrolyte disorders (AOR: 3.67, P < 0.01), and preoperative chronic kidney disease (AOR: 1.80, P = 0.03) were predictors of morbidity in patients. In conclusion, Kidney autotransplantation is associated with low mortality but a high morbidity rate. The most common indications of kidney autotransplantation are renal artery and ureter pathologies, respectively. A kidney transplant failure rate of 10.7 per cent was observed in patients with kidney autotransplantation. The most common postoperative complication was hemorrhagic in nature.
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