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Guerra G, Abreu P, Manzi J, Riella J, Vianna R. 218.6: Robotic-assisted donor nephrectomy: Innovation advancing patient care. Transplantation 2023; 107:51. [PMID: 37845924 DOI: 10.1097/01.tp.0000993276.90315.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
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Riella J, Tabbara MM, Alvarez A, DeFreitas MJ, Chandar J, Gaynor JJ, González J, Ciancio G. Pediatric kidney transplants with multiple renal arteries show no increased risk of complications compared to single renal artery grafts. Front Pediatr 2022; 10:1058823. [PMID: 36589161 PMCID: PMC9800822 DOI: 10.3389/fped.2022.1058823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background Kidney allografts with multiple renal arteries (MRA) are not infrequent and have been historically associated with a higher risk of developing vascular and urologic complications. Reports of kidney transplantation using MRA allografts in the pediatric population remain scarce. The aim of this study was to evaluate if transplantation of allografts with MRA with a surgical intent of creating a single arterial inflow using vascular reconstruction techniques when required, and without the routine use of surgical drains or ureteral stents, is associated with an increased risk of complications when compared to single renal artery (SRA) grafts. Methods We retrospectively analyzed all pediatric renal transplant recipients performed by a single surgeon at our center between January 2015 and June 2022. Donor and recipient demographics, intraoperative data, and recipient outcomes were included. Recipients were divided into two groups based on SRA vs. MRA. Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables. Comparisons of those distributions between the two groups were performed using standard chi-squared and t-tests. Time-to-event distributions were compared using the log-rank test. Results Forty-nine pediatric transplant recipients were analyzed. Of these, 9 had donors with MRA (Group 1) and 40 had donors with SRA (Group 2). Native kidney and liver mobilization was performed in 44.4% (4/9) of Group 1 vs. 60.0% (24/40) of Group 2 cases (p = 0.39). There were no cases of delayed graft function or graft primary nonfunction. No surgical drainage or ureteral stents were used in any of the cases. One patient in Group 2 developed a distal ureter stricture. The geometric mean serum creatinine at 6- and 12-months posttransplant was 0.7 */ 1.2 and 0.9 */ 1.2 mg/dl in Group 1 and 0.7 */ 1.1 and 0.7 */ 1.1 mg/dl in Group 2. Two death-censored graft failures were observed in Group 2, with no significant difference observed between the two groups (p = 0.48). Conclusions Our study demonstrates that pediatric renal transplantation with MRA grafts, using a surgical approach to achieve a single renal artery ostium, can be safely performed while achieving similar outcomes as SRA grafts and with a low complication rate.
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Affiliation(s)
- Juliano Riella
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Marina M. Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Angel Alvarez
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Marissa J. DeFreitas
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Pediatrics, Division of Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Jayanthi Chandar
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Pediatrics, Division of Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Jeffrey J. Gaynor
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Javier González
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
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Riella J, Ferreira R, Tabbara MM, Abreu P, Ernani L, Defreitas M, Chandar J, Gaynor JJ, González J, Ciancio G. Retroperitoneal kidney transplantation with liver and native kidney mobilization: a safe technique for pediatric recipients. World J Pediatr 2022; 19:489-501. [PMID: 36474085 PMCID: PMC10149446 DOI: 10.1007/s12519-022-00658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pediatric kidney transplant (KT) using larger, deceased or living donor adult kidneys can be challenging in the pediatric population due to limited space in the retroperitoneum. Liver and native kidney (L/NK) mobilization techniques can be used in smaller and younger transplant recipients to aid in retroperitoneal placement of the renal allograft. Here, we compare the clinical outcomes of pediatric retroperitoneal KT with and without L/NK mobilization. METHODS We retrospectively analyzed pediatric renal transplant recipients treated between January 2015 and May 2021. Donor and recipient demographics, intraoperative data, and recipient outcomes were included. Recipients were divided into two groups according to the surgical technique utilized: with L/NK mobilization (Group 1) and without L/NK mobilization (Group 2). Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables. Tests of association with the likelihood of using L/NK mobilization were performed using standard χ2 tests, t tests, and the log-rank test. RESULTS Forty-six pediatric recipients were evaluated and categorized into Group 1 (n = 26) and Group 2 (n = 20). Recipients in Group 1 were younger (6.7 ± 0.8 years vs. 15. 3 ± 0.7, P < 0.001), shorter (109.5 ± 3.7 vs. 154.2 ± 3.8 cm, P < 0.001) and weighed less (21.4 ± 2.0 vs. 48.6 ± 3.4 kg, P < 0.001) than those in Group 2. Other baseline characteristics did not differ between Groups 1 and 2. One urologic complication was encountered in Group 2; no vascular or surgical complications were observed in either group. Additionally, no stents or drains were used in any of the patients. There were no cases of delayed graft function or graft primary nonfunction. The median follow-up of the study was 24.6 months post-transplant. Two patients developed death-censored graft failure (both in Group 2, P = 0.22), and there was one death with a functioning graft (in Group 2, P = 0.21). CONCLUSIONS Retroperitoneal liver/kidney mobilization is a feasible and safe technique that facilitates implantation of adult kidney allografts into pediatric transplant recipients with no increased risk of developing post-operative complications, graft loss, or mortality.
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Affiliation(s)
- Juliano Riella
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Raphealla Ferreira
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Marina M Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Phillipe Abreu
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Lucas Ernani
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Marissa Defreitas
- Department of Pediatrics, Division of Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Jayanthi Chandar
- Department of Pediatrics, Division of Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Jeffrey J Gaynor
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA
| | - Javier González
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. .,Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. .,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 NW 9Th Ave, 7Th Floor, Miami, FL, 33136, USA.
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Tabbara MM, Guerra G, Riella J, Abreu P, Alvarez A, Vianna R, Chen L, Morsi M, Gaynor JJ, Gonzalez J, Ciancio G. Creating a Single Inflow Orifice From Living Donor Kidney Allografts With Multiple Renal Arteries. Transpl Int 2022; 35:10212. [PMID: 35497891 PMCID: PMC9046561 DOI: 10.3389/ti.2022.10212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
Background: Multiple renal arteries (MRA) are often encountered during living-donor kidney transplantation (LDKT), requiring surgeons to pursue complex renovascular reconstructions prior to graft implantation. With improvements in reconstruction and anastomosis techniques, allografts with MRA can be successfully transplanted with similar outcomes to allografts with a single renal artery. Here, we describe in detail various surgical techniques for reconstruction of MRA grafts with the intent of creating a single arterial inflow. Methods: We retrospectively reviewed the medical records of all LDKT recipients with laparoscopically procured MRA kidneys between March 2008 and July 2021. Recipient and donor characteristics, operative data, type of reconstruction, and recipient outcomes were analyzed. The primary outcomes were the incidence of developing delayed graft function (DGF) and/or a vascular or urological complication within 12 months post-transplant. Results: Seventy-three LDKT recipients of MRA donor allografts were evaluated. Two renal arteries (RA) were encountered in 62 allografts (84.9%) and three RA in 11 allografts (15.1%). Renal artery reconstruction was performed in 95.8% (70/73) of patients. Eighteen different reconstruction techniques of MRA were utilized, the most common being side-to-side anastomosis in allografts with two RA (N = 44) and side-to-side-to-side anastomosis in allografts with three RA (N = 4). Interposition grafting was performed in seven cases (9.6%). A single ostium was created in 69 cases (94.5%), and the median warm ischemia time was 27 (range 20–42) minutes. None of the patients developed DGF or post-operative vascular or urological complications. Median creatinine at 3, 6, and 12 months post-transplant remained stable at 1.1 mg/dl. With a median follow-up of 30.4 months post-transplant, only one graft failure has been observed–death-censored graft survival was 98.6%. Conclusion: Complex reconstruction techniques to create a single renal artery ostium for graft implantation anastomosis in allografts with MRA show acceptable warm ischemic times, with no increased risk of post-operative vascular or urological complications.
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Affiliation(s)
- Marina M Tabbara
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Giselle Guerra
- Division of Nephrology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Juliano Riella
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Phillipe Abreu
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Angel Alvarez
- Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Rodrigo Vianna
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Linda Chen
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Mahmoud Morsi
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Jeffrey J Gaynor
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida
| | - Javier Gonzalez
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida.,Miami Transplant Institute, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida.,Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
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