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Kim J, Yang SJ, Kim DG, Han WK, Na JC. Robotic ureter reconstruction using the native ureter to treat long-segment ureteral stricture of the transplant kidney utilizing Indocyanine green: The first Korean experience. Investig Clin Urol 2023; 64:154-160. [PMID: 36882174 PMCID: PMC9995958 DOI: 10.4111/icu.20220364] [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: 11/07/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE Ureteral strictures are a common complication after kidney transplantation. Open reconstruction is preferred for long-segment ureteral strictures that cannot be resolved endoscopically; however, it is known to have the potential to fail. We report 2 successful cases of robotic reconstruction surgery of a transplant ureter using the native ureter with the aid of intraoperative Indocyanine green (ICG). MATERIALS AND METHODS Patients were placed in semi-lateral position. Using Da Vinci Xi, the transplant ureter was dissected, and the stricture site was identified. End-to-side anastomosis of the native ureter to the transplant ureter was performed. ICG was utilized to identify the course of the transplant ureter and confirm the vascularity of the native ureter. RESULTS Case 1: A 55-year-old female underwent renal transplantation at another hospital. She had recurrent febrile urinary tract infections (UTIs) and a ureteral stricture requiring percutaneous nephrostomy (PCN). The PCN and ureteral stent were removed successfully after surgery. The patient had only 1 febrile UTI episode after surgery. Case 2: A 56-year-old female underwent renal transplantation at another hospital. She had acute pyelonephritis 1-month post-transplantation, and a long-segment ureteral stricture was identified. She developed a UTI with anastomosis site leakage in the early postoperative period, which resolved with conservative treatment. The PCN and ureteral stent were removed 6 weeks after surgery. CONCLUSIONS Robotic surgery for managing long-segment ureteral stricture after kidney transplantation is safe and feasible. The use of ICG during surgery to identify the ureter course and its viability can improve the success.
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Affiliation(s)
- Jinu Kim
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - Seok Jeong Yang
- Department of Surgery, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Deok Gie Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woong Kyu Han
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - Joon Chae Na
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea.
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Implementation of donation after circulatory death kidney transplantation can safely enlarge the donor pool: A systematic review and meta-analysis. Int J Surg 2021; 92:106021. [PMID: 34256169 DOI: 10.1016/j.ijsu.2021.106021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/14/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Donation after circulatory death (DCD) kidney transplantation has been introduced to address organ shortage. However, DCD kidneys are not accepted worldwide due to concerns about inferior quality. To investigate whether these concerns are justified, we performed a systematic review and meta-analysis to investigate DCD graft outcomes compared to donation after brain death (DBD). MATERIALS AND METHODS EMBASE, Medline, Cochrane, Web of Science and Google Scholar were searched from database inception until September 2020. Exclusion criteria were studies reporting on pediatric/dual kidney transplants, multi-organ transplants or studies including normothermic perfusion techniques. The primary outcome was graft survival. Secondary outcomes were primary non-function (PNF), delayed graft function (DGF), 3-months biopsy-proven acute rejection (BPAR), 1-year estimated Glomerular Filtration Rate (eGFR), patient survival, and urologic complications. A random-effects model was used for meta-analysis. Meta-regression analysis was performed in case of high between-study heterogeneity. RESULTS Fifty-one studies were included, comprising 73,454 DCD and 518,229 DBD recipients. One-year graft loss was increased in DCD recipients (death-censored: risk ratio (RR) 1.10 (95%-confidence interval (CI) 1.04-1.16), all-cause: RR 1.13 (95%-CI 1.08-1.19)). Ten-year graft loss was similar to DBD (death-censored: RR 1.02 (95%-CI 0.92-1.13), all-cause: RR 1.03 (95%-CI 0.94-1.13)). DCD recipients had an increased risk of PNF (RR 1.43 (95%-CI 1.26-1.62)), DGF (RR 2.02 (95%-CI 1.88-2.16)), and 1-year mortality (RR 1.10 (95%-CI 1.01-1.21)). No differences were observed for 3-months BPAR, ureter stenosis/leakage, 1-year eGFR and 10-year mortality. CONCLUSION Long-term DCD kidney transplant outcomes are similar to DBD despite a higher risk of PNF, DGF, and a 13% increased risk of graft loss in the first year after transplantation. These results should encourage implementation of DCD programs.
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Mesnard B, Leroy M, Hunter J, Kervella D, Timsit MO, Badet L, Glemain P, Morelon E, Buron F, Le Quintrec-Donnette M, Pernin V, Ladriere M, Girerd S, Legendre C, Sicard A, Albano L, De Vergie S, Kerleau C, Prudhomme T, Rigaud J, Cantarovich D, Blancho G, Karam G, Giral M, Ville S, Branchereau J. Kidney transplantation from expanded criteria donors: an increased risk of urinary complications - the UriNary Complications Of Renal Transplant (UNyCORT) study. BJU Int 2021; 129:225-233. [PMID: 34114727 DOI: 10.1111/bju.15509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the impact of expanded criteria donors (ECD) on urinary complications in kidney transplantation. PATIENTS AND METHODS The UriNary Complications Of Renal Transplant (UNyCORT) is a cohort study based on the French prospective Données Informatisées et VAlidées en Transplantation/Computerized and VAlidated Data in Transplantation (DIVAT) cohort. Data were extracted between 1 January 2002 and 1 January 2018 with 1-year minimum follow-up, in relation to 44 pre- and postoperative variables. ECD status was included according to United Network for Organ Sharing (UNOS) definition. The primary outcome of the UNyCORT study was the association between the donor's ECD/standard criteria donors (SCD) status and urinary complications at 1 year in uni- and multivariate analysis. Sub-group analysis, stratified analysis on ECD/SCD donor's status and transplant failure analysis were then conducted. RESULTS Between 1 January 2002 and 1 January 2018, 10 279 kidney transplants in adult recipients were recorded within the DIVAT network. A total of 8559 (83.4%) donors were deceased donors and 1699 (16.6%) were living donors (LD). Among donation after circulatory death (DCD) donors, 224 (2.85%) were uncontrolled DCD and 93 (1.09%) were controlled DCD donors. A total of 3617 (43.9%) deceased donors were ECD. The overall urological complication rate was 16.26%. The donor's ECD status was significantly associated with an increased risk of urological complications at 1 year in multivariate analysis (odds ratio: 1.50, 95% CI 1.31-1.71; P < 0.001) and especially with stenosis and ureteric fistulae at 1 year. There is no association with LD, uncontrolled and controlled DCD. The placement of an endo-ureteric stent was beneficial in preventing urinary complications in all donors and particularly in ECD donors. CONCLUSION The donor's ECD status is associated with a higher likelihood of stenosis and ureteric fistulae at 1 year. Recipients of grafts from ECD donors should probably be considered for closer urological monitoring and systematic preventive measures.
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Affiliation(s)
- Benoit Mesnard
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Maxime Leroy
- Plateforme de Méthodologie et de Biostatistique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - James Hunter
- Nuffield Department of Surgical Science, Oxford, UK
| | - Delphine Kervella
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | | | - Lionel Badet
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | - Pascal Glemain
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | - Fanny Buron
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices de Lyon, Lyon, France
| | | | - Vincent Pernin
- Service de Néphrologie-Soins Intensifs-Dialyse et Transplantation, Hôpital Lapeyronie, Montpellier, France
| | - Marc Ladriere
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | - Sophie Girerd
- Service de Transplantation Rénale, CHU Brabois, Nancy, France
| | | | | | | | | | - Clarisse Kerleau
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Thomas Prudhomme
- Service Urologie, Andrologie et Transplantation Rénale, CHU de Toulouse, Hôpital Rangeuil, Toulouse, France
| | - Jérôme Rigaud
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Diego Cantarovich
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Gilles Blancho
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Georges Karam
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France
| | - Magali Giral
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Simon Ville
- CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
| | - Julien Branchereau
- Clinique Urologique, CHU de Nantes, Hôpital Hôtel Dieu, Nantes, France.,Nuffield Department of Surgical Science, Oxford, UK.,CRTI UMR 1064, Inserm, Université de Nantes, Nantes, France.,ITUN, CHU Nantes, Nantes, France.,RTRS Centaure, Nantes, France
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Churchill BM, Sharma A, Aziz D, Halawa A. Identifying Early Extraperitoneal High-Volume Urine Leak Post Kidney Transplantation. EUROPEAN MEDICAL JOURNAL 2021. [DOI: 10.33590/emj/20-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Transplant clinicians need to be watchful of several potential surgical complications in the early post-transplant period, including haemorrhage, extraperitoneal urine leak, and lymphocele. While haemorrhage and extraperitoneal urine leak usually present in the early post kidney transplant period, lymphoceles usually present 2–6 weeks after transplantation. While the colour and volume of the drained fluid can give some indication of the problem, is not enough evidence for a confident urine leak diagnosis. Further investigations, such as serum biochemical parameter analysis of the drained fluid and ultrasonography, help to identify the true cause. This paper discusses how to identify high-volume extraperitoneal urine leaks in the early post kidney transplant period and considers the differential diagnoses. Different ureteroneocystostomy procedures, including the Lich–Grégoir, Politano–Leadbetter, and U-stitch techniques, are discussed and compared regarding complication rates (especially urine leak and haematuria). The authors also address the management of low- and high-volume extraperitoneal urine leak, the follow-up needed, and the impact of urine leak on graft and patient survival, length of hospital stay, and rate of hospital readmission.
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Affiliation(s)
| | - Ajay Sharma
- Postgraduate Education in Transplantation, University of Liverpool, Liverpool, UK; Department of Transplantation, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Davis Aziz
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Ahmed Halawa
- Postgraduate Education in Transplantation, University of Liverpool, Liverpool, UK; Sheffield Kidney Institute, Sheffield Teaching Hospitals, Sheffield, UK
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