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Françot M, Mesnard B, Kerleau C, Chelghaf I, de Vergie S, Perrouin Verbe MA, Rigaud J, Karam G, Supiot S, Rio E, Blancho G, Giral M, Branchereau J. Kidney transplantation after pelvic radiotherapy: Increased morbidity? THE FRENCH JOURNAL OF UROLOGY 2024; 34:102667. [PMID: 38849036 DOI: 10.1016/j.fjurol.2024.102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION The impact of pelvic irradiation on kidney transplant surgery is still unclear. The main objective of our study is to evaluate the feasibility and the safety of renal transplantation following pelvic radiotherapy. METHODS We collected characteristics and kidney transplant data from patients with a history of pelvic cancer treated with pelvic irradiation between 2005 and 2021. These data were collected via the prospective information system "Computerized Data Validated in Transplantation" (DIVAT) and medical records. We carried out a comparative study with a non-irradiated matched control group to compare the data of intraoperative surgeries, complications reported postoperatively as well as survival of the graft and the patient. Patients were matched on age, sex, side of graft implantation, and graft rank. RESULTS Twenty-four patients were collected with an average age of 65, 18 patients were treated for prostatic adenocarcinoma, 4 for gynecological cancer and 2 testicular cancers. Twenty-one patients were treated by radiotherapy, 3 by brachytherapy. Eight patients had a target dose on the iliac lymph nodes. The comparative study showed a significant difference in operative difficulty (n=15 versus n=1, P<0.01), operative duration (190min versus 149min, P=0.005), occurrence of lymphocele (P=0.041). Urinary anastomosis surgical techniques were different, 83.3% of control patients had an uretero-vesical anastomosis against 58.3% of patients with a history of irradiation (P=0.057) and about 29% of irradiated patients had an uretero-ureteral anastomosis. There was no other significant difference in per and postoperative criteria or survival. DISCUSSION A history of pelvic irradiation significantly increases the technical complexity of kidney transplantation without impacting safety and kidney graft survival. A history of pelvic irradiation should not be a contraindication to kidney transplant. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Marc Françot
- Department of Urology, Nantes University Hospital, Nantes, France.
| | - Benoit Mesnard
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Clarisse Kerleau
- Center for Research in Transplantation and Translational Immunology, Nantes University Hospital, Nantes, France
| | - Ismael Chelghaf
- Department of Urology, Nantes University Hospital, Nantes, France
| | | | | | - Jérome Rigaud
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Georges Karam
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Stéphane Supiot
- Department of Radiotherapy, West Cancer Institute, Nantes University Hospital, Saint-Herblain, France
| | - Emmanuel Rio
- Department of Radiotherapy, West Cancer Institute, Nantes University Hospital, Saint-Herblain, France
| | - Gilles Blancho
- Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France
| | - Magali Giral
- Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France
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Zhu LJ, Lin H, Wu XT, Shi SH, Qiao X. Analysis of risk factors and prognosis of diarrhea after renal transplantation. Technol Health Care 2024; 32:2069-2080. [PMID: 38393930 DOI: 10.3233/thc-230579] [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] [Indexed: 02/25/2024]
Abstract
BACKGROUND Diarrhea is a prevalent complication after renal transplantation. OBJECTIVE To examine the risk factors for diarrhea after renal transplantation, evaluate their combined predictive values, and analyze the prognosis. METHODS Clinical data of patients who underwent allogeneic renal transplantation in the Second People's Hospital of Shanxi Province from January 2019 to March 2020 were retrospectively analyzed, cases were screened and grouped, independent risk factors for diarrhea after renal transplantation were analyzed by univariate analysis and multivariate analysis, and their predictive value was evaluated by receiver operating characteristic (ROC) curve. The survival time of recipient grafts in diarrhea and non-diarrhea groups were evaluated by Kaplan-Meier and log-rank test. RESULTS We included 166 recipients in the study and the incidence of diarrhea was 25.9%; univariate and logistic regression multivariate analyses revealed that independent risk factors for diarrhea in recipients were that the type of renal transplant donor was DCD (donation after circulatory death), immunity induction was onducted with basiliximab + antithymocyte globulin (ATG), and ATG alone, the type of mycophenolic acid (MPA) used was mycophenolate mofetil capsules, and delayed graft function (DGF) occurred after transplantation. The ROC curve indicated that the combination of the four factors had good accuracy in predicting the occurrence of diarrhea in recipients. The graft survival rate two years after the operation in the diarrhea group was significantly lower than that in the non-diarrhea group. CONCLUSION Diarrhea affected the two-year survival rate of the graft. The type of donor, immunity induction scheme, and the type of MPA and DGF were independent risk factors for diarrhea in recipients, and the combination of the four factors had good prognostic prediction value.
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Affiliation(s)
- Li-Jun Zhu
- Department of Kidney Transplantation and Dialysis Center, The Second People's Hospital of Shanxi Province, Taiyuan, Shanxi, China
- Department of Kidney Transplantation and Dialysis Center, The Second People's Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Hui Lin
- Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Kidney Transplantation and Dialysis Center, The Second People's Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Xiao-Tong Wu
- Department of Kidney Transplantation and Dialysis Center, The Second People's Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Shao-Hua Shi
- Department of Kidney Transplantation and Dialysis Center, The Second People's Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Xi Qiao
- Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Graveleau A, Kervella D, Kerleau C, Lavallée E, Chelghaf I, de Vergie S, Karam G, Perrouin-Verbe MA, Rigaud J, Blancho G, Giral M, Branchereau J. [Surgical outcomes and complications following third kidney transplantation]. Prog Urol 2023; 33:427-436. [PMID: 37169706 DOI: 10.1016/j.purol.2023.04.002] [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: 01/31/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND After two consecutive kidney transplant failures, a third kidney transplantation improves survival for patients on the waiting list. The surgical outcomes and complications of third kidney transplantations remain poorly known. METHODS We analyzed the last 100 third kidney transplantations performed in our center between January 2000 and August 2018. The data, relating to donors and recipients, were extracted retrospectively from medical records and from the prospective DIVAT database (computerized and validated data in transplantation). Continuous variables are expressed as means, medians, first and third quartiles (median, [Q1;Q3]). Categorical variables are expressed as percentages. Patient and transplant survivals were calculated using the Kaplan-Meier method. RESULTS Mean age of recipients was 46.4 years (47, [36;53]). Thirty-five percent had kidney failure due to urinary tract malformations. Mean age of donors was 48.2 years (52, [39.75; 58]) with 63% of donors with standard criteria. Mean cold ischemia time was 22.4hours (21, [16.5; 29.2]). Surgical mortality rate was 2% and surgical complication rate was 45%. Third kidney transplants survival was 73.1% and 58.8% at 5 years and 10 years. Mortality rate with a functioning transplant was 18%. CONCLUSION A third kidney transplant offers satisfactory functional outcomes but remains associated with high morbi-mortality and a significant death rate with a functioning transplant. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Aurélien Graveleau
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Delphine Kervella
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Clarisse Kerleau
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Etienne Lavallée
- Département de chirurgie et centre de recherche sur le cancer, division d'urologie, université Laval, Québec, Canada
| | - Ismael Chelghaf
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Stéphane de Vergie
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Georges Karam
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | | | - Jérôme Rigaud
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Gilles Blancho
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Magali Giral
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Julien Branchereau
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France.
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Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green. J Clin Med 2022; 11:jcm11216585. [PMID: 36362813 PMCID: PMC9656022 DOI: 10.3390/jcm11216585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Ureteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indocyanine green (ICG) fluorescence angiography. This bicentric historic cohort study, conducted between November 2015 and December 2019, included 196 kidney transplantations. The associations between quantitative perfusion parameters of near-infrared fluorescence angiography with ICG and the occurrence of different grades of ureterovesical anastomosis complications in the context of donor, recipient, periprocedural, and postoperative characteristics were evaluated. Post-transplant ureterovesical anastomosis complications occurred in 18%. Complications were defined and graded into three categories. They were associated with the time on dialysis (p = 0.0025), the type of donation (p = 0.0404), and the number of postoperative dialysis sessions (p = 0.0173). Median ICG ingress at the proximal ureteral third was 14.00 (5.00–33.00) AU in patients with and 23.50 (4.00–117.00) AU in patients without complications (p = 0.0001, cutoff: 16 AU, sensitivity 70%, specificity 70%, AUC = 0.725, p = 0.0011). The proposed definition and grading of post-transplant ureterovesical anastomosis complications is intended to enable valid comparisons between studies. ICG Fluorescence angiography allows intraoperative quantitative assessment of ureteral microperfusion during kidney transplantation and is able to predict the incidence of ureterovesical anastomosis complications. Registration number: NCT-02775838.
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Prudhomme T, Karam G, Roumiguié M, Bardet F, Sallusto F, Soulié M, Gamé X, Kamar N, Phé V, Pradère B, Blancho G, Lechevallier É, Branchereau J. [Pedagogical impact of a MOOC on surgical technique of kidney transplantation]. Prog Urol 2021; 32:226-239. [PMID: 34920921 DOI: 10.1016/j.purol.2021.11.001] [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: 09/14/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the educational impact of a pilot MOOC (Massive Open Online Course), validated by the French College of Urology Teachers (FCUT), on the surgical technique of kidney transplantation. MATERIALS AND METHODS We developed a MOOC on the surgical technique of kidney transplantation, based on a video of a surgical procedure, performed by an expert surgeon. The MOOC has been validated by the FCUT. We have created 2 student groups: 1) MOOC-pre-QCM group: visualization of the MOOC then answer to the MCQs and satisfaction questions; 2) MOOC-post-QCM group: answer to the MCQs then visualization of the MOOC then answers to the satisfaction questions. In total, 20 MCQs on the kidney transplantation technique were completed by the 2 groups. The answers were anonymous. RESULTS A total of 142 people answered the MCQs (MOOC-pre-QCM group (n=66) and MOOC-post-QCM group (n=76)). Twenty-nine percent (41/142) of the participants were fellows and 71 % (101/142) were residents. The proportion of fellows and residents was identical between the 2 groups. The rate of correct answers to the 20 MCQs was statistically higher in the MOOC-pre-QCM group, compared to the MOOC-post-QCM group (88.6 % versus 73.3 %, P<0.0001). Ninety-one percent of students found the MOOC "Very Useful" or "Useful". The median MOOC rating, given by students, was 8/10. CONCLUSION This study showed a positive impact of the MOOC on theoretical knowledge of kidney transplantation surgical technique. This MOOC could serve as a pilot project for the development of other MOOCs on urological surgery. LEVEL 3.
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Affiliation(s)
- Thomas Prudhomme
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France; Institut de transplantation-urologie-néphrologie, CHU de Nantes, Nantes, France; Inserm UMR 1064, centre de recherche en transplantation et immunologie, université de Nantes, Nantes, France.
| | - Georges Karam
- Institut de transplantation-urologie-néphrologie, CHU de Nantes, Nantes, France; Inserm UMR 1064, centre de recherche en transplantation et immunologie, université de Nantes, Nantes, France
| | - Mathieu Roumiguié
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France
| | | | - Féderico Sallusto
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France
| | - Michel Soulié
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France
| | - Xavier Gamé
- Département d'urologie, de transplantation rénale et d'andrologie, CHU de Toulouse, Toulouse, France
| | - Nassim Kamar
- Département de néphrologie et de transplantation d'organe, CHU de Toulouse, Toulouse, France
| | - Véronique Phé
- Collège français des enseignants en urologie, maison de l'urologie, 11, rue Viète, Paris, France
| | - Benjamin Pradère
- Collège français des enseignants en urologie, maison de l'urologie, 11, rue Viète, Paris, France
| | - Gilles Blancho
- Institut de transplantation-urologie-néphrologie, CHU de Nantes, Nantes, France; Inserm UMR 1064, centre de recherche en transplantation et immunologie, université de Nantes, Nantes, France
| | - Éric Lechevallier
- Collège français des enseignants en urologie, maison de l'urologie, 11, rue Viète, Paris, France
| | - Julien Branchereau
- Institut de transplantation-urologie-néphrologie, CHU de Nantes, Nantes, France; Inserm UMR 1064, centre de recherche en transplantation et immunologie, université de Nantes, Nantes, France; Collège français des enseignants en urologie, maison de l'urologie, 11, rue Viète, Paris, France
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