1
|
Mang J, Haag J, Liefeldt L, Budde K, Peters R, Hofbauer SL, Schulz M, Weinberger S, Dagnæs-Hansen J, Maxeiner A, Ralla B, Friedersdorff F. Transplant nephrectomy: indication, surgical approach and complications-experiences from a single transplantation center. World J Urol 2024; 42:120. [PMID: 38446250 PMCID: PMC10917844 DOI: 10.1007/s00345-024-04884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
PURPOSE Management of a failed kidney allograft, and the question whether it should be removed is a challenging task for clinicians. The reported risks for transplant nephrectomy (TN) vary, and there is no clear recommendation on indications or surgical approach that should be used. This study gives an overview of indications, compares surgical techniques, and identifies risk factors for higher morbidity. METHODS Retrospective analysis was conducted on all transplant nephrectomies performed between 2005 and 2020 at Charité Hospital Berlin, Department of Urology. Patient demographics, laboratory parameters, graft survival data, indication for TN, and surgical complications were extracted from medical reports. RESULTS A total of 195 TN were performed, with graft intolerance syndrome being the most common indication in 52 patients (26.7%), acute rejection in 36 (18.5%), acute infection in 30 (15.4%), and other reasons to stop immunosuppression in 26 patients (13.3%). Rare indications were vascular complications in 16 (8.2%) and malignancies in the allograft in six (3.1%) cases. Extracapsular surgical approach was significantly more often used in cases of vascular complications and earlier allograft removal, but there was no difference in complication rates between extra- and intracapsular approach. Acute infection was identified as an independent risk factor for a complication grade IIIb or higher according to Clavien-Dindo classification, with a HR of 12.3 (CI 2.2-67.7; p = 0.004). CONCLUSION Transplant nephrectomy should only be performed when there is a good indication, and non-elective surgery should be avoided, when possible, as it increases morbidity.
Collapse
Affiliation(s)
- Josef Mang
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Josephine Haag
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Peters
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian L Hofbauer
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Schulz
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Weinberger
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Julia Dagnæs-Hansen
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernhard Ralla
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.
| |
Collapse
|
2
|
McDonald M. Allograft nephrectomy vs. no nephrectomy for failed renal transplants. FRONTIERS IN NEPHROLOGY 2023; 3:1169181. [PMID: 37675360 PMCID: PMC10479781 DOI: 10.3389/fneph.2023.1169181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/13/2023] [Indexed: 09/08/2023]
Abstract
The role of allograft nephrectomy (AN) in failed renal transplants is a topic of debate, owing to controversial results reported in the literature and the fact that most of the studies are limited by a retrospective design and small numbers of participants. Allograft nephrectomy is most likely of benefit in the patient with recurrent allograft intolerance syndrome (AIS) following pulse steroids. Immunosuppression weaning in the presence of clinical signs related to a chronic inflammatory state is also reasonable grounds to pursue AN. Studies are mainly inconclusive but suggest that AN has no overall benefit for allograft survival after retransplant. This topic is still of interest in the transplant field and is particularly relevant for patients who are likely to require retransplantation within their lifetime. Further assessment is needed in the form of randomized controlled trials that control for various AN indications and immunosuppression regimens, and have clearly defined survival outcomes.
Collapse
Affiliation(s)
- Michelle McDonald
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
3
|
Malik MS, Akoh JA, Houlberg K. A Study Protocol Exploring the Role of an Implantable Doppler Probe in Kidney Transplantation: A Feasibility Randomized Controlled Trial with an Embedded Qualitative Study. EXP CLIN TRANSPLANT 2023; 21:493-503. [PMID: 37455469 DOI: 10.6002/ect.2023.0031] [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: 07/18/2023]
Abstract
OBJECTIVES Vascular complications in kidney transplant surgery constitute one-third of early graft loss, which can be prevented by timely diagnosis of vascular compromise. A blood flow monitoring device may have a beneficial role in the early identification of graft hypoperfusion critical to reducing graft loss. This research protocol aims to evaluate the potential of an implantable Doppler probe as a blood flow monitoring device in kidney transplant recipients. MATERIALS AND METHODS The potential study will be a mixed methodology, 2-arm feasibility randomized controlled trial with an embedded qualitative study. For the trial, we will compare demographic characteristics and outcome measures of kidney transplant patients receiving implantable Doppler probe monitoring (intervention group, n = 30) with those having standard clinical care (control group). For the qualitative study, we will conduct semi-structured interviews with stakeholders (n = 12) recruited by purposive sampling to explore experiences of participants. All interviews will be audio recorded with verbatim transcription. RESULTS Our results will use the summarized quantitative data and descriptive statistics to determine differences between the groups. We will use CONSORT guidelines to determine the suitability of the research processes, availability of research resources, and potential challenges faced during the feasibility randomized controlled trial. We will use thematic analysis and NVivo software to analyze the acceptability of the intervention in clinical practice. We will compile the results according to the consolidated criteria for reporting qualitative research checklist. CONCLUSIONS The goal of this protocol is to determine the feasibility of an implantable Doppler probe monitoring device in kidney transplant recipients. The feasibility study will collect preliminary information, fill gaps in evidence, and test research processes for the pragmatic future randomized controlled trial. The template of this study is transferable to other transplant centers across the United Kingdom.
Collapse
|
4
|
Hindi H, Harb A. Role of failed renal allograft embolization in the treatment of graft intolerance syndrome. J Clin Imaging Sci 2023; 13:3. [PMID: 36751563 PMCID: PMC9899480 DOI: 10.25259/jcis_109_2022] [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: 09/04/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
Nearly, 20% of renal allografts fail after 5 years resulting in a return to hemodialysis. These patients subsequently undergo withdrawal of immunosuppressant therapy, and the failed allograft is left in situ. However, many patients (40%) develop graft intolerance syndrome, characterized by fever, pain, and hematuria. Conventionally, this is managed with low-dose maintenance immunosuppressant therapy, however, that is not without notable adverse risk. In refractory patients, transplant nephrectomy is the treatment of choice; however, this caries significant morbidity and mortality. Interventional radiology plays a substantial role of treating graft intolerance syndrome while delivering improved patient outcomes.
Collapse
Affiliation(s)
- Hussam Hindi
- Department of Radiology, Wayne State University/DMC, Detroit, Michigan, United States.,Corresponding author: Hussam Hindi, Department of Radiology, Wayne State University/DMC, Detroit, Michigan, United States.
| | - Ali Harb
- Department of Radiology, Wayne State University/DMC, Detroit, Michigan, United States
| |
Collapse
|
5
|
McCabe M, Osinski T, Kashyap R, Taylor J, Schuler N, Shepard L, Ghazi A, Helbig K, Dokus MK, Nair A, Pineda-Solis K, Orloff M, Wu G. Robotic Assisted Transplant Nephrectomy: Case Series and Training Model for Improving Adoption. JSLS 2023; 27:JSLS.2022.00079. [PMID: 36818765 PMCID: PMC9913067 DOI: 10.4293/jsls.2022.00079] [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: 02/18/2023] Open
Abstract
Introduction Open transplant nephrectomy for failed renal allograft is an invasive procedure associated with significant perioperative morbidity and mortality. Minimally invasive surgical approaches have improved a variety of patient outcomes for many surgeries. Thus, robotic assisted transplant nephrectomy (RATN) potentially offers significant patient benefit. Although previously reported, there remains a paucity of data on RATN outcomes and techniques. Methods Four perfused, high-fidelity hydrogel models were created using previously described techniques and used for simulated RATN. Subsequently performed institutional cases were included for analysis. Intra- and postoperative variables along with patient demographics were retrospectively obtained through parsing of patient records. Results Simulated nephrectomy time was 67.33 minutes (35.75 - 98.91). Five patients underwent RATN. There were four male and one female patients. The average age was 47 years. The most common indication was abdominal pain secondary to rejection (3/5). Mean blood loss was 188 mL; mean operative time was 243 minutes, and mean length of stay was 4.5 days. Intraoperatively there were two incidences of small cystotomies. One patient was readmitted within 30 days for intraabdominal abscess. Conclusion This study adds to the growing literature around RATN, demonstrating the feasibility of the technique and reporting good outcomes for this cohort.
Collapse
Affiliation(s)
- Michael McCabe
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Thomas Osinski
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Randeep Kashyap
- Department of Abdominal Transplantation, University of Rochester Medical Center, Rochester, NY
| | - Jeremy Taylor
- Department of Medicine – Nephrology, University of Rochester Medical Center, Rochester, NY
| | - Nathan Schuler
- Simulation Innovation Lab, University of Rochester Medical Center, Rochester, NY
| | - Lauren Shepard
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, NY.,Simulation Innovation Lab, University of Rochester Medical Center, Rochester, NY
| | - Katie Helbig
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - M. Katherine Dokus
- Department of Abdominal Transplantation, University of Rochester Medical Center, Rochester, NY
| | - Amit Nair
- Department of Abdominal Transplantation, University of Rochester Medical Center, Rochester, NY
| | - Karen Pineda-Solis
- Department of Abdominal Transplantation, University of Rochester Medical Center, Rochester, NY
| | - Mark Orloff
- Department of Abdominal Transplantation, University of Rochester Medical Center, Rochester, NY
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
6
|
Gunawardena T, Ridgway D. Transplant Nephrectomy: Current Concepts. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:716-725. [PMID: 37955463 DOI: 10.4103/1319-2442.389431] [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: 11/14/2023] Open
Abstract
Kidney transplantation is the gold standard treatment option for patients with endstage kidney disease. As the number of waitlisted patients increases, the gap between supply and demand for suitable donor kidneys keeps widening. The adoption of novel strategies that expand the donor pool has attenuated this issue to a certain degree, and this has led to a progressive increase in the number of annual transplants performed. As transplanted kidneys have a finite lifespan, there is a reciprocal rise in the number of patients who return to dialysis once their allograft fails. The clinicians involved in the management of such patients are left with the problem of managing the nonfunctioning allograft. The decision to undertake transplant nephrectomy (TN) in these patients is not straightforward. Allograft nephrectomy is a procedure that is associated with significant morbidity and mortality. It will have implications for the outcomes of the subsequent transplant. In this review, we aimed to compressively discuss the indications, techniques, and outcomes of TN, which is an integral component of the management of a failing allograft.
Collapse
Affiliation(s)
- Thilina Gunawardena
- Department of Renal Transplant, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | |
Collapse
|
7
|
Harsányi M, Lázár G, Szederkényi E, Hódi Z, Rárosi F, Keresztes C, Borda B. [Early and late graftectomies in patients during a 5-year period - single unit data from the Department of Surgery, University of Szeged]. Magy Seb 2022; 75:8-11. [PMID: 35333771 DOI: 10.1556/1046.2022.10002] [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: 10/19/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
Introduction. The rate of graft failure after kidney transplantation is 7–10% in the first year and 3–5% in subsequent years. The indication and exact timing of graftectomy is a matter of debate in some cases, particularly in the case of asymptomatic grafts that are no longer functioning. Methods. Data of patients who underwent kidney transplantation at the Transplantation Unit, Department of Surgery, Szeged, Hungary between January 1, 2015 and December 31, 2020 were analyzed. We reviewed the indications, timing and complications of graftectomies and compared early and late graftectomies. Results. 294 kidney transplants were performed during the study period. 37 patients (13%) of them underwent graftectomy. The most common indications were bleeding 11 (30%), arterial circulatory disorders 8 (22%), v. renal thrombosis 7 (19%), mixed active antibody and ongoing cellular rejection 7 (19%), and acute humoral rejection 4 (10%). Graftectomies were performed in 26 cases with inoperative and in 11 cases with functional graft. Comparing early and late graftectomies, 15 cases (40%) underwent early graftectomy within 30 days after transplantation and 22 cases (60%) underwent late graftectomy. Conclusions. The most common cause of graftectomies in the study period was acute bleeding, which is also due to disturbed homeostasis in chronic renal failure. In the case of the early ones, emergency surgery and in the vast majority of late graftectomies, elective surgery was performed.
Collapse
Affiliation(s)
- Márton Harsányi
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország
| | - György Lázár
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország
| | - Edit Szederkényi
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország
| | - Zoltán Hódi
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország
| | - Ferenc Rárosi
- 2 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Orvosi Fizikai és Orvosi Informatikai Intézet, Szeged, Magyarország
| | - Csilla Keresztes
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Orvosi Szaknyelvi Kommunikációs és Fordítóképző Csoport, Szeged, Magyarország
| | - Bernadett Borda
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország
| |
Collapse
|
8
|
Wells MW, Rampazzo A, Papay F, Gharb BB. Two Decades of Hand Transplantation: A Systematic Review of Outcomes. Ann Plast Surg 2022; 88:335-344. [PMID: 35113506 DOI: 10.1097/sap.0000000000003056] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hand transplantation for upper extremity amputation provides a unique treatment that restores form and function, which may not be achieved by traditional reconstruction and prosthetics. However, despite enhancing quality of life, hand transplantation remains controversial, because of immunological complications, transplant rejection, and medication effects. This systematic literature review sought to collect information on current experiences and outcomes of hand transplants to determine the efficacy and utility of hand transplants. The databases PubMed, Scopus, and Embase were analyzed with combinations of "hand" or "upper extremity" or "arm" and "transplant" or "allograft," with information collected on recipient characteristics, details of transplant, immunological outcomes, functional outcomes, and complications. Functional outcomes, as measured by Disabilities of Arm, Shoulder and Hand score, were compared between patient groups using Wilcoxon signed-rank test or 1-way analysis of variance test and post hoc Tukey test. Within the 108 articles that fulfilled inclusion and exclusion criteria, there were 96 patients with 148 hand transplants. There were 57 patients who experienced acute rejection and 5 patients with chronic rejection. Disabilities of the Arm, Shoulder and Hand scores significantly decreased after hand transplantation and were significantly lower for distal transplants compared with proximal transplants. There were 3 patients with concurrent face transplantation and 2 patients with simultaneous leg transplants. Sixteen patients experienced amputation of the hand transplant, and there were 5 deaths. This study found that hand transplantation provides significant restoration of function and form, especially for proximal transplants. Reduction in complications, such as rejection and amputation, can be achieved by decreasing medication cost and patient education.
Collapse
Affiliation(s)
- Michael W Wells
- From the Case Western Reserve University, School of Medicine
| | | | - Francis Papay
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | | |
Collapse
|
9
|
Singh D, Aryala S. Repair of large ruptured infected pseudoaneurysm of iliac artery with transposition of internal iliac artery after an allograft nephrectomy. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_115_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
10
|
Aikpokpo NV, Sharma A, Halawa A. Management of the Failing Kidney Transplant: Challenges and Solutions. EXP CLIN TRANSPLANT 2021; 20:443-455. [PMID: 34763628 DOI: 10.6002/ect.2021.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The kidneys are the most transplanted organs, and the number of failed kidney transplants that require reinstitution of renal replacement therapy in patients is on the increase. Increased mortality has been noted in patients with failed grafts compared with transplant- naïve patients with chronic kidney disease who are treated with dialysis. Issues such as management of immunosuppression, the need for transplant nephrectomy, addressing the increased risk of cardiovascular events, malignancies, and infections are debatable and often based on individual or hospital practices. The optimal timing and modality of renal replacement therapy to be reinitiated are sometimes blurred, with considerable variations among physician practices. Guidelines are therefore needed to appropriately manage this special population of patients with the aim of improving outcomes. Here, our objective was to review the current practices in managing patients with failing kidney transplants so that recommendations can be made based on the available evidence.
Collapse
Affiliation(s)
- Ngozi Virginia Aikpokpo
- From the Institute of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,the Department of Internal Medicine, Babcock university Teaching Hospital, Ilisan, Ogun State, Nigeria
| | | | | |
Collapse
|
11
|
Bains L, Bahadur A, Lal P, Bhatia R, Singh N, Kaur D. Epiploic Appendagitis: A Riddle for Right Lower Quadrant Pain! Case Rep Gastroenterol 2021; 15:525-532. [PMID: 34616251 PMCID: PMC8454249 DOI: 10.1159/000514775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/22/2021] [Indexed: 01/18/2023] Open
Abstract
Epiploic appendagitis (EA) is inflammation of epiploic appendages, which are pedunculated fatty structures, extend from the cecum to the rectosigmoid junction, and are covered by the peritoneum. Torsion, infarction, and inflammation of it present with acute lower abdominal pain and localized tenderness in a well-looking patient. It poses as diagnostic conundrum due to its rarity and not picked by conventional radiography. A 50-year-old male presented with pain in RLQ for past 1 day, which kept on increasing without any other symptoms. His abdomen was soft with tenderness localized to the right lower quadrant (RLQ), classically at McBurney's point along with mild peritonism. Rest laboratory test, chest, and abdominal X-ray were normal except slight leukocytosis. Ultrasound was inconclusive. A working clinical diagnosis of appendicitis was made. Patient did not consent for surgery and was started on antibiotics with pain killers. With no significant improvement, he underwent CT scan which revealed focal area of soft-tissue attenuation along the lateral wall of ascending colon with fat stranding. He was diagnosed as EA and improved on conservative treatment. EA of RLQ of abdomen mimics acute appendicitis and can be considered as an uncommon differential diagnosis in presence of radiological findings of normal-appearing appendix. CT is the investigation of choice, and treatment is essentially conservative. Further, if appendix is found normal at exploration, surrounding epiploic appendages of the cecum and ascending colon should also be evaluated carefully for inflammation/hematoma/gangrene, besides looking for Meckel's diverticulum.
Collapse
Affiliation(s)
- Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Akshay Bahadur
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Pawan Lal
- Department of Surgery, Dr. Hedgewar Arogya Sansthan, Delhi, India
| | - Rahul Bhatia
- Department of Surgery, Dr. Hedgewar Arogya Sansthan, Delhi, India
| | | | - Daljit Kaur
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Rishikesh, India
| |
Collapse
|
12
|
Jahmunah V, Ng EYK, San TR, Acharya UR. Automated detection of coronary artery disease, myocardial infarction and congestive heart failure using GaborCNN model with ECG signals. Comput Biol Med 2021; 134:104457. [PMID: 33991857 DOI: 10.1016/j.compbiomed.2021.104457] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 01/02/2023]
Abstract
Cardiovascular diseases (CVDs) are main causes of death globally with coronary artery disease (CAD) being the most important. Timely diagnosis and treatment of CAD is crucial to reduce the incidence of CAD complications like myocardial infarction (MI) and ischemia-induced congestive heart failure (CHF). Electrocardiogram (ECG) signals are most commonly employed as the diagnostic screening tool to detect CAD. In this study, an automated system (AS) was developed for the automated categorization of electrocardiogram signals into normal, CAD, myocardial infarction (MI) and congestive heart failure (CHF) classes using convolutional neural network (CNN) and unique GaborCNN models. Weight balancing was used to balance the imbalanced dataset. High classification accuracies of more than 98.5% were obtained by the CNN and GaborCNN models respectively, for the 4-class classification of normal, coronary artery disease, myocardial infarction and congestive heart failure classes. GaborCNN is a more preferred model due to its good performance and reduced computational complexity as compared to the CNN model. To the best of our knowledge, this is the first study to propose GaborCNN model for automated categorizing of normal, coronary artery disease, myocardial infarction and congestive heart failure classes using ECG signals. Our proposed system is equipped to be validated with bigger database and has the potential to aid the clinicians to screen for CVDs using ECG signals.
Collapse
Affiliation(s)
- V Jahmunah
- Department of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - E Y K Ng
- Department of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
| | | | - U Rajendra Acharya
- School of Engineering, Ngee Ann Polytechnic, Singapore; Biomedical Engineering, School of Social Science and Technology, Singapore University of Social Sciences, Singapore; International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto, Japan; Department Bioinformatics and Medical Engineering, Asia University, Taiwan; School of Management and Enterprise, University of Southern Queensland, Australia.
| |
Collapse
|
13
|
Bonani M, Achermann R, Seeger H, Scharfe M, Müller T, Schaub S, Binet I, Huynh-Do U, Dahdal S, Golshayan D, Hadaya K, Wüthrich RP, Fehr T, Segerer S. Dialysis after graft loss: a Swiss experience. Nephrol Dial Transplant 2021; 35:2182-2190. [PMID: 32170950 DOI: 10.1093/ndt/gfaa037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 01/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients returning to dialysis after graft loss have high early morbidity and mortality. METHODS We used data from the Swiss Transplant Cohort Study to describe the current practice and outcomes in Switzerland. All patients who received a renal allograft between May 2008 and December 2014 were included. The patients with graft loss were divided into two groups depending on whether the graft loss occurred within 1 year after transplantation (early graft loss group) or later (late graft loss group). Patients with primary non-function who never gained graft function were excluded. RESULTS Seventy-seven out of 1502 patients lost their graft during follow-up, 40 within 1 year after transplantation. Eleven patients died within 30 days after allograft loss. Patient survival was 86, 81 and 74% at 30, 90 and 365 days after graft loss, respectively. About 92% started haemodialysis, 62% with definitive vascular access, which was associated with decreased mortality (hazard ratio = 0.28). At the time of graft loss, most patients were on triple immunosuppressive therapy with significant reduction after nephrectomy. One year after graft loss, 77.5% (31 of 40) of patients in the early and 43.2% (16 out of 37) in the late-loss group had undergone nephrectomy. Three years after graft loss, 36% of the patients with early and 12% with late graft loss received another allograft. CONCLUSION In summary, our data illustrate high mortality, and a high number of allograft nephrectomies and re-transplantations. Patients commencing haemodialysis with a catheter had significantly higher mortality than patients with definitive access. The role of immunosuppression reduction and allograft nephrectomy as interdependent factors for mortality and re-transplantation needs further evaluation.
Collapse
Affiliation(s)
- Marco Bonani
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Rita Achermann
- Department Transplant Immunology and Nephrology, University Basel Hospital, Basel, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Michael Scharfe
- Department of Clinical Research, Clinical Trial Unit, University Basel Hospital, Basel, Switzerland
| | - Thomas Müller
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Stefan Schaub
- Department of Clinical Research, Clinical Trial Unit, University Basel Hospital, Basel, Switzerland
| | - Isabelle Binet
- Division of Nephrology/Transplantation Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, University of Bern, Bern, Switzerland
| | - Suzan Dahdal
- Department of Nephrology and Hypertension, University of Bern, Bern, Switzerland
| | - Dela Golshayan
- Transplantation Center, CHUV University Hospital, Lausanne, Switzerland
| | - Karine Hadaya
- Division of Nephrology, Geneva University Hospital, Geneva, Switzerland
| | - Rudolf P Wüthrich
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Kantonsspital Graubünden, Chur, Switzerland
| | - Stephan Segerer
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland.,Division of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
14
|
Tomonari M, Kobayashi A, Yamamoto I, Hatanaka S, Kawabe M, Yamakawa T, Katsumata H, Katsuma A, Mafune A, Nakada Y, Koike Y, Miki J, Kimura T, Tanno Y, Yamamoto H, Yokoo T. A Case of Transplant Nephrectomy due to Chronic Graft Intolerance Syndrome. Nephron Clin Pract 2020; 144 Suppl 1:102-107. [PMID: 33242860 DOI: 10.1159/000511558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022] Open
Abstract
We report a case of graft intolerance syndrome in which transplant nephrectomy was performed 11 years after kidney transplantation. A 46-year-old man was admitted to our hospital in February 2018 with a mild fever, left lower abdominal pain, and gross hematuria with enlargement of the transplanted kidney. Urinary tract infection was ruled out. Because the symptoms developed after the immunosuppressants had been stopped after kidney graft loss, graft intolerance syndrome was suspected. He had lost his graft in 2016 and had stopped all immunosuppressants since January of 2017. Immunosuppressive therapy was intensified, and steroid half-pulse therapy was added for 3 days. After the steroid pulse therapy, the C-reactive protein (CRP) decreased from 6.47 mg/dL to 0.76 mg/dL, but there was little improvement in the symptoms, and the CRP then increased to 4.44 mg/dL. Transplant nephrectomy was performed in March 2018. Postoperatively, the symptoms disappeared without the administration of immunosuppressants, and the CRP decreased. Pathologically, the resected kidney graft showed persistent active allograft rejection with severe endarteritis, transplant glomerulopathy, and diffuse interstitial fibrosis. Massive thrombi occluded the large arteries, and there was extensive hemorrhagic cortical necrosis. Transplant nephrectomy is uncommon in patients >6 months after transplantation. However, even if more time has passed since transplantation, as in this case, transplant nephrectomy may be a valid option in some cases of severe graft intolerance syndrome.
Collapse
Affiliation(s)
- Masahiro Tomonari
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akimitsu Kobayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan,
| | - Izumi Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Saeko Hatanaka
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Mayuko Kawabe
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yamakawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruki Katsumata
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Ai Katsuma
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Aki Mafune
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Nakada
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Koike
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yudo Tanno
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyasu Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
15
|
Nabavizadeh R, Noorali AA, Makhani SS, Hong G, Holzman S, Patil DH, Kim FY, Tso PL, Turgeon NA, Ogan K, Master VA. Transplant Radical Nephrectomy and Transplant Radical Nephroureterectomy for Renal Cancer: Postoperative and Survival Outcomes. Ann Transplant 2020; 25:e925865. [PMID: 33093437 PMCID: PMC7590527 DOI: 10.12659/aot.925865] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The treatment of complex tumors in non-functioning renal transplants requiring surgical extirpation is challenging. Here, we report the largest series of patients who underwent transplant radical nephrectomy for renal cell carcinoma (RCC) and transplant radical nephroureterectomy for urothelial cell carcinoma (UCC) in their transplanted kidneys. MATERIAL AND METHODS From 2004 to 2018, 10 patients underwent transplant radical nephrectomy (7 patients) and nephroureterectomy (3 patients). Retrospective analyses, in terms of complications, oncological recurrence, and survival, of peri-operative and long-term outcomes, were performed. RESULTS Out of the 10 patients, 7 had RCC and 3 had UCC. No intraoperative mortality occurred. Three patients presented with Clavien-Dindo grade IIIa or greater within 30 days of surgery. Two patients died within 60 days of surgery, both due to vascular events: one due to myocardial infarction and one due to stroke. Two other patients died: one after 2.9 years, due to myocardial infarction, and the other after 6 years, due to unknown reasons. At the 7-year follow-up, there was a 60% overall survival rate. For all patients, average survival post-nephrectomy was approximately 4.5 years, including the 6 living patients and 4 deceased patients. Importantly, there was no observed cancer recurrence. CONCLUSIONS This study reports outcomes of the largest series of transplant radical nephrectomy and nephroureterectomy for malignancies of renal allografts. In the optimized setting, extirpative surgeries appear safe, with favorable long-term oncological and survival outcomes.
Collapse
Affiliation(s)
- Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Gordon Hong
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Sarah Holzman
- Department of Urology, University of California Irvine and Children's Hospital, Orange, CA, USA
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Frances Y Kim
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Paul L Tso
- Department of Transplant Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicole A Turgeon
- Department of Transplant Surgery, University of Texas Dell Medical School, Austin, TX, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| |
Collapse
|
16
|
Renal artery embolization of non-functioning graft: an effective treatment for graft intolerance syndrome. LA RADIOLOGIA MEDICA 2020; 126:494-497. [PMID: 33047296 DOI: 10.1007/s11547-020-01294-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Percutaneous renal artery embolization is a valid non-invasive technique alternative to nephrectomy for patients with symptomatic non-functioning allograft (graft intolerance syndrome-GIS). The purpose of this article is to report the experience of our centre. METHODS We analysed retrospectively 15 patients with symptomatic non-functioning renal allograft treated with percutaneous embolization from 2003 to 2017. Occlusion was obtained with the injection of calibrated microspheres of increasing size (from 100 to 900 μm) and completed with 5 to 8 mm metal coils placement in the renal artery. RESULTS Technical success was achieved in all cases at the end of the procedure. Clinical success was obtained in 11 patients (73%). In four cases, nephrectomy was necessary: in one case because of septic fever and in three cases because of GIS persistence. In one case, it was possible to perform another procedure to embolize a perirenal collateral from a lumbar artery. Four patients (27%) reported minor complications which spontaneously resolved during the hospital stay. CONCLUSIONS According to the scientific literature, we believe that, in selected patients, percutaneous renal artery embolization is a valid treatment option for GIS thanks to its efficacy, repeatability, minimal invasiveness and the absence of severe complications.
Collapse
|
17
|
Rubinz R, Andaçoğlu OM, Anderson E, Corder W, Michaelson E, Moore J, Cooper M, Ghasemian S. Transplant nephrectomy with peritoneal window: Georgetown University experience. Turk J Surg 2020; 35:191-195. [PMID: 32550327 DOI: 10.5578/turkjsurg.4122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/03/2018] [Indexed: 11/15/2022]
Abstract
Objectives Transplant nephrectomy is a technically challenging procedure with high complication rates. Morbidity and mortality are mostly due to hemorrhage or infection and are reported to be 17-60% and 1-39%, respectively. The most common surgical technique for transplant nephrectomy is sub-capsular, extraperitoneal approach which may result in fluid accumulation and subsequent super-infection. We report that intraperitoneal approach, after assuring hemostasis of the transplant pedicle, allows for passive drainage, decreases hematoma formation and minimizes the subsequent infection risk in the nephrectomy bed. Material and Methods From July 2009 to July 2014 a total of 38 transplant nephrectomies were performed using the intraperitoneal window technique at Georgetown University MedStar Transplant Institute (MGTI). Data was collected retrospectively. Results Average age at the time of transplant nephrectomy was 43.9 ± 14.3, and the majority were male (55.3%). Mean time to nephrectomy was 71.7 ± 67.4 months following transplantation. Indications for nephrectomy included pain, hematuria, fever, and recalcitrant rejection. Average operative time was 97.1 ± 28.9 minutes, average blood loss was 172.5 ± 213.6 mL. A total of 9 (24%) complications occurred. Postoperative blood transfusion was the most common complication (15.7%) followed by 2 (5.3%) re-interventions; one take back for hematoma and one percutaneous drain placement for symptomatic fluid collection. We had no infection, postoperative sepsis, ICU admissions, or mortality. Conclusion Transplant nephrectomy with peritoneal window is a technique with better results compared to the literature. An opening between the transplant cavity and the peritoneum allows for passive drainage of fluid and minimizes the risk of hematoma and abscess formation. This approach does not add significant time to the operation, furthermore it may decrease morbidity and mortality by reducing overall complications, namely hematoma formation and infection, which overall decreases rates of re-interventions and length of hospital stay.
Collapse
Affiliation(s)
- Rachel Rubinz
- Department of Urology, Georgetown University School of Medicine, Washington, USA
| | - Oya M Andaçoğlu
- Georgetown University MedStar Transplant Institute, Washington, USA
| | - Erik Anderson
- Department of Urology, Georgetown University School of Medicine, Washington, USA
| | - William Corder
- Department of Urology, Georgetown University School of Medicine, Washington, USA
| | - Evan Michaelson
- Department of Urology, Georgetown University School of Medicine, Washington, USA
| | - Jack Moore
- Georgetown University MedStar Transplant Institute, Washington, USA
| | - Matthew Cooper
- Georgetown University MedStar Transplant Institute, Washington, USA
| | - Seyed Ghasemian
- Department of Urology, Georgetown University School of Medicine, Washington, USA.,Georgetown University MedStar Transplant Institute, Washington, USA
| |
Collapse
|
18
|
Garcia-Padilla PK, Afanador D, Gonzalez CG, Yucuma D, Uribe J, Romero A. Renal Graft Embolization as a Treatment for Graft Intolerance Syndrome. Transplant Proc 2020; 52:1187-1191. [PMID: 32173594 DOI: 10.1016/j.transproceed.2020.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Renal graft intolerance syndrome is an inflammatory process that occurs in up to 40% of patients with graft loss. It is characterized by fever, graft pain, hematuria, and anemia. Traditionally, the treatment has been nephrectomy; however, this procedure is associated with high morbidity and mortality rates. As an alternative, graft embolization is associated with success rates of up to 92%. In this study, we describe the graft embolization experience of 1 center, its clinical outcomes and complications. METHODS An observational, retrospective study was conducted. It included all patients with graft intolerance syndrome undergoing graft embolization between 2012 and 2018. The success of the procedure was defined by the resolution of the symptoms that motivated the embolization. RESULTS We found 12 cases of patients undergoing embolization. The time of presentation of the graft intolerance syndrome after admission to dialysis was 6 months (range, 0.6-13). The main clinical manifestation was pain in the area of the graft and macroscopic hematuria. Except for 1 patient, all continued with the immunosuppressive treatment regimen after graft loss for 4 months (range, 0.6-9), received antibiotics for 5.5 days (range, 2-14), and 10 patients received steroid treatment for 6.5 days (range, 5-10). The main complication, secondary to the procedure, was hematoma at the puncture site in 3 patients. Only 1 patient had postembolization syndrome, which resolved with steroid administration. Two patients required postembolization nephrectomy due to persistent renal blood flow and symptoms such as pain and hematuria. The average hospital stay was 5.5 days (range, 1-24). CONCLUSIONS Renal graft embolization is an effective technique as a treatment strategy in patients with clinical signs of intolerance syndrome, with a success rate ≥83.3%, low morbidity, and short hospital stay; furthermore, it avoids the potential complications of a surgical nephrectomy. Graft infection should be ruled out before embolization, and the use of prophylactic antibiotics and steroid therapy is recommended to reduce the risk of postembolization syndrome and infectious complications.
Collapse
Affiliation(s)
- Paola Karina Garcia-Padilla
- Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia.
| | - Diana Afanador
- Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Camilo Gonzalez Gonzalez
- Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Daniela Yucuma
- College of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Jorge Uribe
- Department of Radiology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| | - Alejandro Romero
- Department of Radiology, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio. Bogotá, Colombia
| |
Collapse
|
19
|
Marinhox A, Tavares da Silva E, Moreira P, Roseiro A, Parada B, Marconi L, Nunes P, Simões P, Santos L, Rodrigues L, Romãozinho C, Bastos CA, Figueiredo A. Transplantectomy in the First 3 Months After Renal Transplantation: Experience of a Reference Center. Transplant Proc 2020; 52:196-203. [PMID: 31926743 DOI: 10.1016/j.transproceed.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/25/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION/OBJECTIVE Transplantation is the treatment of choice in end-stage renal disease. However, there are complications that require transplantectomy. The objective of this study was to evaluate predictive factors for transplantectomy in the first 3 months after renal transplantation. MATERIAL AND METHODS This retrospective study included 770 kidney transplants performed between June 2011 and June 2017. Logistic regression was applied to study the relationship between independent variables and the occurrence of transplantectomy. RESULTS Analyzing variables of the recipients, it was verified that age over 65 years; body mass index; dialysis time; history of previous transplant and comorbidities such as obesity, overweight, hypertension, diabetes mellitus, dyslipidemia, peripheral arterial disease; or history of a thrombotic episode were not predictive factors. It was found that the use of expanded criteria donors, their age, or cause of death were not predictive factors. The use of a right renal graft or grafts with multiple arteries; the duration of surgery; the performance of surgery at dawn; the need for transfusion; the cold ischemia time; and hemodynamic parameters at reperfusion (central venous pressure, systolic or diastolic blood pressure) were not predictive factors. The recipient age at transplantation (p = .014; B=-0.059; Exp(B)=0.943 [0.899-0.988]) and reoperation in the first 10 days after transplantation (p < .001; B= -2.574; Exp(B)=0.076 [0.028-0.210]) were predictive factors. CONCLUSION Reoperation in the first 10 days after transplantation decreased the risk of transplantectomy in the first 3 months. The lower the age of the recipient, the greater the risk of transplantectomy.
Collapse
Affiliation(s)
- Ana Marinhox
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal.
| | - Edgar Tavares da Silva
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Pedro Moreira
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| | - António Roseiro
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Belmiro Parada
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Lorenzo Marconi
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Pedro Nunes
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Pedro Simões
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Lídia Santos
- Service of Nephrology of Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Luís Rodrigues
- Service of Nephrology of Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Catarina Romãozinho
- Service of Nephrology of Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Carlos Alberto Bastos
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Service of Urology and Renal Transplantation of the Hospital and University Center of Coimbra, Coimbra, Portugal
| |
Collapse
|
20
|
Muramatsu M, Hyodo Y, Sheaff M, Aikawa A, Yaqoob M, Puliatti C. Impact of Transplant Nephrectomy for Patient Survival Over the Past 15 Years: A Single-Center Study. EXP CLIN TRANSPLANT 2018; 17:580-587. [PMID: 30295584 DOI: 10.6002/ect.2018.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES How transplant nephrectomy affects patient survival after return to dialysis is unclear. Here, we compared patient survival after graft loss between patients with and without transplant nephrectomy. MATERIALS AND METHODS We divided 171 patients who received transplant between 2000 and 2015 and had graft loss into 3 groups: 64 had graft failure left in situ (without nephrectomy), 51 had nephrectomy < 3 months posttransplant (early nephrectomy), and 56 patients had nephrectomy > 3 months posttransplant (late nephrectomy). The primary endpoint was patient survival. Risk factors for patient death were also analyzed. Secondary endpoints included relisting for transplant and immunosuppressive agent status. RESULTS Patient survival rates at 1, 3, and 5 years posttransplant in those without nephrectomy, early nephrectomy, and late nephrectomy were 92.1% /90.5%/86.6%, 96.0%/89.7%/80.4%, and 100.0% /97.9%/ 95.6%, respectively. Rates in patients with early nephrectomy differed significantly from those with late nephrectomy (P = .005). On multivariate analysis, patient survival was affected by relisting for transplant (hazard ratio 0.17; 95% confidence interval, 0.06-0.41; P < .001) and graft survival duration (hazard ratio 0.36, 95% confidence interval, 0.13-0.93; P = .036). Relisting for transplant occurred in 46.9% of patients without nephrectomy, 56.9% of patients with early nephrectomy, and 51.8% of patients with late nephrectomy. Those with late nephrectomy took 14.7 months after graft loss to relist for transplant, with 7.8 months for those without nephrectomy (P = .039) and 6.3 months for those with early nephrectomy (P = .051). Only 10.9% of those without nephrectomy were immunosuppressive free, which was in contrast to 94.1% and 78.6% of those with early and late nephrectomy, respectively. CONCLUSIONS After graft failure, patients without nephrectomy did not have inferior survival versus patients who received early or late nephrectomy. Graft survival time and relisting for transplant were associated with patient survival regardless of having transplant nephrectomy.
Collapse
Affiliation(s)
- Masaki Muramatsu
- From the Nephrology and Transplantation Department, The Royal London Hospital, London, United Kingdom
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
Progress in patient care and immunosuppressive medications has resulted in improved allograft survival in the early posttransplant period; however, substantial graft loss continues in the long term. Therefore, the number of dialysis patients with failed allografts is increasing progressively. These patients have a worse prognosis than naive dialysis patients. Cardiovascular causes are the leading cause of death, followed by infections and malignancies. Delay in return to dialysis, a chronic inflammatory state, infections, and cancer are contributing factors to mortality, whereas type of dialysis modality does not have a significant effect on outcomes. Graft nephrectomy is a risky operation; therefore, it should not be a routine procedure and rather should be performed only when indicated. Overall, most grafts are left in place, whereas graft nephrectomy is performed in atients with graft intolerance syndrome. Management of immunosuppressive drugs after graft failure is controversial. In the case of maintaining immunosuppression, there is increased risk of infections, cardiovascular diseases, and malignancies and also steroid-related adverse effects. On the other hand, discontinuation of immunosuppressants may result in loss of residual allograft function and also acute graft inflammation. Together, immunosuppressive drugs are almost always discontinued in these patients because of their inherent adverse effects. Considering the sequence of cessation, first antiproliferative drugs are stopped, followed by calcineurin inhibitors, and finally steroids. Because many studies show a clear survival benefit, every attempt should be made for a retransplant in patients with failed renal allografts.
Collapse
Affiliation(s)
- Ali Riza Ucar
- From the Department of Internal Medicine, Division of Nephrology, Istanbul School of Medicine, Millet Caddesi, Capa, Istanbul, Turkey
| | | | | |
Collapse
|
22
|
Review: Management of patients with kidney allograft failure. Transplant Rev (Orlando) 2018; 32:178-186. [DOI: 10.1016/j.trre.2018.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/18/2018] [Accepted: 03/21/2018] [Indexed: 12/25/2022]
|
23
|
Mazdak H, Ghavami M, Dolatkhah S, Daneshpajouhnejad P, Fesharakizadeh M, Fesharakizadeh S, Atapour A, Mahzouni P, Hashemi M, Salajegheh R, Taheri D. Pathological assessment of allograft nephrectomy: An Iranian experience. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2018; 23:55. [PMID: 30057639 PMCID: PMC6040153 DOI: 10.4103/jrms.jrms_440_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/20/2017] [Accepted: 04/16/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study was to determine the pathologic causes of renal allograft failure in transplant nephrectomy specimens. MATERIALS AND METHODS In this cross-sectional study performed in the referral transplant center of Isfahan, Iran, medical files of all patients who underwent nephrectomy in 2008-2013 were studied. Age at transplantation, sex, donor's characteristics, causes of primary renal failure, duration of allograft function, and pathologic reasons of nephrectomy were extracted. Slides of nephrectomy biopsies were evaluated. Data were analyzed using SPSS. RESULTS Medical files of 39 individuals (male: 56.4%; mean age: 35.1 ± 16.0 years) were evaluated. The main disease of patients was hypertension (17.9%), and most cases (64.1%) were nephrectomized < 6 months posttransplantation. Renal vein thrombosis (RVT) (51.3%) and T-cell-mediated rejection (TCMR) (41.0%) were the most prevalent causes of transplanted nephrectomy. Cause of primary renal failure was correlated to nephrectomy result (P = 0.04). TCMR was the only pathologic finding in all of patients nephrectomized >2 years posttransplantation. There were 14 cases in which biopsy results showed a relationship between primary disease of patients and pathologic assessment of allograft (P = 0.04). A significant relationship between transplantation-nephrectomy interval and both the nephrectomy result and histopathologic result existed (P < 0.0001). A relationship between primary allograft biopsy appearance and further assessment of nephrectomized specimen (P < 0.001) existed as well. CONCLUSION The most pathologic diagnoses of nephrectomy in a period of less than and more than 6 months posttransplantation were RVT and TCMR, respectively. Early obtained allograft protocol biopsy is suggested, which leads to better diagnosis of allograft failure.
Collapse
Affiliation(s)
- Hamid Mazdak
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Ghavami
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahaboddin Dolatkhah
- Department of Pathology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parnaz Daneshpajouhnejad
- Isfahan Medical Students’ Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Pathology, Isfahan Kidney Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Fesharakizadeh
- Department of Surgery, Najaf Abad Branch of Islamic Azad University, Isfahan, Iran
| | | | - Abdolamir Atapour
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Mahzouni
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mozaffar Hashemi
- Department of Thoracic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roxana Salajegheh
- Department of Pathology, Faculty of Medicine, Yazd University of Medical Sciences, Yazd, Iran
| | - Diana Taheri
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
24
|
Bunthof KLW, Verhoeks CM, van den Brand JAJG, Hilbrands LB. Graft intolerance syndrome requiring graft nephrectomy after late kidney graft failure: can it be predicted? A retrospective cohort study. Transpl Int 2017; 31:220-229. [DOI: 10.1111/tri.13088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/21/2017] [Accepted: 10/23/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Kim L. W. Bunthof
- Department of Nephrology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Carmen M. Verhoeks
- Department of Nephrology; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Luuk B. Hilbrands
- Department of Nephrology; Radboud University Medical Center; Nijmegen The Netherlands
| |
Collapse
|
25
|
Aung NN, Irish A, Swaminathan R, Burrows S, Fidler S, D'Orsogna L. Graft nephrectomy for people with a failed kidney transplant. Hippokratia 2016. [DOI: 10.1002/14651858.cd012377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nyi Nyi Aung
- Fiona Stanley Hospital; Nephrology and Renal Transplantation; 102-118 Murdoch Drive Murdoch WA Australia 6150
| | - Ashley Irish
- Fiona Stanley Hospital; Nephrology and Renal Transplantation; 102-118 Murdoch Drive Murdoch WA Australia 6150
| | - Ramyasuda Swaminathan
- Fiona Stanley Hospital; Nephrology and Renal Transplantation; 102-118 Murdoch Drive Murdoch WA Australia 6150
| | - Sally Burrows
- University of Western Australia; Medicine and Pharmacology RPH Unit; 35 Stirling Highway Crawley WA Australia 6009
| | - Samantha Fidler
- Fiona Stanley Hospital; Department of Immunology; 102-118 Murdoch Drive Murdoch WA Australia 6150
| | - Lloyd D'Orsogna
- Fiona Stanley Hospital; 102-118 Murdoch Drive Murdoch WA Australia 6150
| |
Collapse
|
26
|
Toth F, Zadori G, Fedor R, Illesy L, Szabo-Pap M, Kanyari Z, Kovacs D, Asztalos L, Nemes B. A Single-center Experience of Allograft Nephrectomies Following Kidney Transplantation. Transplant Proc 2016; 48:2552-2554. [DOI: 10.1016/j.transproceed.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Common Iliac Artery Thrombosis following Pelvic Surgery Resulting in Kidney Allograft Failure Successfully Treated by Percutaneous Transluminal Angioplasty with Balloon-Expandable Covered Stent. Case Rep Nephrol 2015; 2015:291796. [PMID: 26355669 PMCID: PMC4555357 DOI: 10.1155/2015/291796] [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: 06/18/2015] [Accepted: 07/30/2015] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 66-year-old woman who developed acute kidney allograft failure due to thrombotic occlusion of the common iliac artery after hysterectomy requiring emergent allograft rescue. She underwent percutaneous transluminal angioplasty with endovascular balloon expandable covered stent graft placement in the right common iliac artery. Although there are a handful of case reports of acute limb ischemia secondary to acute common iliac artery thrombosis, this is the first case reported in the literature resulting in successful kidney allograft rescue following pelvic surgery.
Collapse
|
28
|
Singh P, Feld RI, Colombe BW, Farber JL, Herman JH, Gulati R, Maley WR, Frank AM. Sensitization, pathologic, and imaging findings comparing symptomatic and quiescent failed renal allografts. Clin Transplant 2014; 28:1424-32. [DOI: 10.1111/ctr.12474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Pooja Singh
- Department of Medicine; Thomas Jefferson University; Philadelphia PA USA
| | - Rick I. Feld
- Department of Radiology; Thomas Jefferson University; Philadelphia PA USA
| | - Beth W. Colombe
- Department of Medicine; Thomas Jefferson University; Philadelphia PA USA
| | - John L. Farber
- Department of Pathology; Thomas Jefferson University; Philadelphia PA USA
| | - Jay H. Herman
- Department of Pathology; Thomas Jefferson University; Philadelphia PA USA
| | - Rakesh Gulati
- Department of Medicine; Thomas Jefferson University; Philadelphia PA USA
| | - Warren R. Maley
- Department of Surgery; Thomas Jefferson University; Philadelphia PA USA
| | - Adam M. Frank
- Department of Surgery; Thomas Jefferson University; Philadelphia PA USA
| |
Collapse
|
29
|
Guo Q, Du X, Zhao Y, Zhang D, Yue L, Wang Z. Ischemic postconditioning prevents renal ischemia reperfusion injury through the induction of heat shock proteins in rats. Mol Med Rep 2014; 10:2875-81. [PMID: 25322861 PMCID: PMC4227421 DOI: 10.3892/mmr.2014.2641] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/20/2014] [Indexed: 01/09/2023] Open
Abstract
Ischemic postconditioning (IPo) attenuates ischemia-reperfusion injuries (IRI) in various organs, of both animals and humans. This study tested the hypothesis that IPo attenuates renal IRI through the upregulation of heat shock protein (HSP)70, HSP27 and heme oxygenase-1 (HO-1, also known as HSP 32) expression. Adult Sprague Dawley rats were subjected to bilateral renal ischemia for 45 min followed by reperfusion for up to 48 h. One group of rats received IPo prior to restoring full perfusion. Another group was administered 100 mg/kg HSP inhibitor quercetin, injected intraperitoneally 1 h prior to ischemia. Control rats received sham operations. Renal IR resulted in severe morphological and pathological changes, with increased serum creatinine and blood urea nitrogen concentrations. IR resulted in increased inflammation by inducing plasma tumor necrosis factor-α and renal nuclear factor kappa-light-chain-enhancer of activated B cells expression. IR also increased lipid peroxidation, as indicated by elevated malondialdehyde content, reduced superoxide dismutase activity and increased renal apoptosis. Renal HSP70, HSP27 and HO-1 mRNA and protein levels were increased by IR and further elevated by IPo. IPo attenuated these changes observed in pathology, lipid peroxidation, apoptosis and inflammation. Quercetin treatment abolished all the protective effects of IPo. In conclusion, this study showed that IPo can attenuate lipid peroxidation, apoptosis and inflammation as well as renal IRI by upregulating the expression of HSP70, HSP27 and HO-1.
Collapse
Affiliation(s)
- Qiongmei Guo
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Xuefang Du
- Department of Anesthesiology, Xingtai Eye Hospital, Xingtai, Hebei 054001, P.R. China
| | - Yanli Zhao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Dong Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Lihui Yue
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Zhenxian Wang
- Department of Urinary Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| |
Collapse
|
30
|
Borges L, Oliveira N, Dias E, Cássio I. Iliac artery pseudoaneurysm: a rare complication following allograft nephrectomy. BMJ Case Rep 2014; 2014:bcr-2013-202596. [PMID: 24700039 DOI: 10.1136/bcr-2013-202596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Our aim is to present a case of a common iliac artery pseudoaneurysm, which complicated an allograft nephrectomy. A 27-year-old woman presented with acute abdominal pain and a palpable pulsatile mass in the right iliac fossa, 1 year after a right pelvic allograft nephrectomy. An iliac pseudoaneurysm was suspected and confirmed on triplex ultrasound and CT angiography. The patient underwent a pseudoaneurysm resection with direct repair of the previous allograft Carrell patch suture dehiscence. The intervention and recovery were uneventful and after a follow-up of 6 months, the patient remains asymptomatic with no clinical or imaging recurrence of the pseudoaneurysm.Vascular complications following allograft nephrectomy are rare but may present significant morbidity and mortality. Endovascular exclusion is currently the preferred option for the management of pseudoaneurysms following allograft nephrectomy; however, open surgical approach remains an alternative for selected patients.
Collapse
Affiliation(s)
- Lisa Borges
- Department of Vascular Surgery, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta delgada, Portugal
| | | | | | | |
Collapse
|