Simultaneous pancreas-kidney (SPK) transplantation is a well-established treatment for patients with insulin-dependent DM complicated by ESRD. The current shortage of cadaver donors and the increasing number of diabetic patients on the transplant waiting list has prompted the use of cadaveric organ from pediatric donors. But the lower age limit of the pancreatic donors has not yet been established. We report the successful result using a 10 years old donor for a 36-year-old SPK transplant recipient.
Adult ; Cadaver ; Child ; Humans ; Kidney Failure, Chronic ; Tissue Donors* ; Transplantation ; Waiting Lists

The results of the third kidney transplantation were complicated owing to previous multiple surgeries. Majority of the third kidney graft have been placed in the iliac fossa after removal of failed previous graft. This technique resulted in bloody dissection and high lympho-vascular complications. Recently, we successfully performed a third kidney transplantation without removal of the failed previous graft. Through the abdominal midline incision, right retroperitoneal space was approached by dissection of cecum and ascending colon to medial reflection. Renal artery was anastomosed to the side of right common iliac artery and renal vein to the side of distal inferior vena cava. After minimum dissection of patient's native ureter, ureteroureterostomy was done over the "double J" catheter. Posttransplant hospital course was uneventful and discharged at 25th postoperative day. Because of naive surgical plane approached through, our procedure would not encounter more complications than usual first or second kidney transplantation.
Catheters ; Cecum ; Colon, Ascending ; Iliac Artery ; Kidney Transplantation* ; Kidney* ; Renal Artery ; Renal Veins ; Reoperation ; Retroperitoneal Space ; Transplants ; Ureter ; Vena Cava, Inferior

PURPOSE: Liver biopsy plays an important role in the histopathological evaluation of the transplanted liver, but till now pretransplant graft biopsy has limited role in predicting primary non function of the graft. Desferrioxamine (DFO), the iron chelating agent, has been known to be effective in reducing rat liver ischemia-reperfusion injury. We tried desferrioxamine in canine partial liver transplantation, and pathologic scores were compared. METHODS: ~70% partial liver was harvested and reimplanted in same mongrel dog weighing about 25 kg. Desferrioxamine (20 mg/kg) was infused via splenic vein just from the beginning of reperfusion of the partial liver graft (n=5). Serum aspartate aminotransferase (AST) Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH) were checked and compared with the control group (n=5). Morphological liver injury score were compared to the control group. Statistical analysis was done with independent T-test. RESULTS: Total ischemic time was 4 hours and 42 minutes in average. AST level was significantly lower in Desferrioxamine group at 1 hour and 48 hours after reperfusion, (P=0.4) ALP level was significantly lower in desferrioxamine group at 48 hours after reperfusion (P=0.4). LDH level in desferrioxamine group was lower than that of control group but without statistical significance. The pathologic score at 1 hour after reperfusion showed a reduced degree of sinusoidal injury among the DFO group but the difference was not statistically significant. The pathologic score just before harvest of the graft showed no correlation with serum AST, ALP, LDH levels at that time or at 1 hour or 48 hours after reperfusion. Only the pathologic score at 1 hour after reperfusion had significant correlation with the serum LDH levels at 48 hours after reperfusion. CONCLUSION: In canine live donor partial liver transplantation, desferrioxamine infusion just before reperfusion might be an effective way of reducing ischemia-reperfusion injury. And the pathologic grading on samples obtained at 1 hour after reperfusion showed a significant correlation with subsequent liver function
Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Biopsy ; Deferoxamine* ; Dogs ; Humans ; Iron ; L-Lactate Dehydrogenase ; Liver Transplantation* ; Liver* ; Rats ; Reperfusion ; Reperfusion Injury ; Splenic Vein ; Tissue Donors ; Transplants

PURPOSE: We have devised a new surgical method of video-assisted minilaparotomy surgery-live donor nephrectomy (VAMS-LDN), which is a hybridized form of laparoscopic and open surgery that combines the advantages of both. We present our series of 202 consecutive patients. METHODS: Since 1993 we have performed 202 successful VAMS-LND. All 202 healthy kidney donors' characteristics and their postoperative courses were retrospectively reviewed and all data were compared to 95 open donor nephrectomies performed during the same period. RESULTS: The mean age and weight of the patients were 37.1+/-9.5 years and 61.6+/-3.3 kg, respectively. The mean operating time was 139+/-39 minutes which was similar to open donor nephrectomy but shorter than laparoscopic donor nephrectomy. There were no major intraoperative complication except two tears to lumbar veins which required transfusion. The mean warm ischemic time was 2.2+/-0.7 minutes which was equal to open donor nephrectomy. Patients experienced less postoperative pain and recovered quicker compared to open donor nephrectomy. CONCLUSION: VAMS-LDN is a safe and minimally invasive technique for live donor nephrectomy, incorporating advantages of both conventional open and laparoscopic methods. VAMS-LDN is a viable option for living donor kidney transplantation.
Humans ; Intraoperative Complications ; Kidney ; Kidney Transplantation ; Laparoscopy ; Laparotomy* ; Living Donors ; Nephrectomy* ; Pain, Postoperative ; Retrospective Studies ; Tissue Donors* ; Veins ; Warm Ischemia

PURPOSE: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation has been varies among authors. While these results suggested that VUR can be a source of repeated infections, which might be a prognostic factor impairing long-term graft function. We evaluated the prevalence, clinical manifestations and diagnostic methods of VUR after living donor kidney transplantation and their proper management with the results of each treatment. METHODS: We reviewed thirty-four patients among five hundreds and thirteen living donor kidney transplant recipients, who developed VUR after the transplantations at our center from June 1998 to June 2003. Twenty-three patients underwent a corrective surgical procedure, ureteroneocystostomy, and we excluded 3 patients who underwent the procedure less than 1 year. The patients were divided into three groups: those with severe VUR underwent a corrective surgical procedure with more than 1 year follow-up (group I, n=20), those with mild VUR underwent a conservative management (group II, n=8) and control group of patients without VUR (group III, n=20). The incidence of urinary tract infection (UTI) and graft function were assessed for 1~7 years. Voiding cystoureterography (VCUG) was performed in patients with recurrent urinary tract infections and reflux was classified from Grade I to Grade IV. RESULTS: We examined immunological and non-immunological risk factors such as age, sex, primary diseases, duration on dialysis, diuresis prior to the treatment, donor selection, the degree of HLA mismatches, cold ischemia time, the incidence of acute rejection. There was no significant demographic difference among study groups except sex (female). Analysis of patients and grafts survival rates revealed no statistical differences among three groups. CONCLUSION: VUR dose not seem to negatively affect graft function if surgical correction were performed in proper period after the diagnosis. The indication of surgical correction of VUR is clinically significant UTIs, UTI sepsis, Grade III or IV VUR. Close attention, proper diagnosis and prompt surgical correction are necessary to minimize the adverse influence of VUR after kidney transplantation.
Cold Ischemia ; Diagnosis ; Dialysis ; Diuresis ; Donor Selection ; Follow-Up Studies ; Humans ; Incidence ; Kidney Transplantation* ; Kidney* ; Living Donors ; Prevalence ; Risk Factors ; Sepsis ; Survival Rate ; Transplantation ; Transplants ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

INTRODUCTION: The majority of urological complications in renal transplantations are related to ureterovesical anastomosis and urological complications continue to be a significant source of morbidity with occasional graft loss and mortality. PURPOSE: We evaluated the impact of the routine placement of double-J ureteral stent for decreasing urological complications after renal transplantation. METHODS: A retrospective study was conducted involving 80 consecutive cadaveric and living donor renal transplantations performed between January 1999 and March 2003. All patients were divided in two groups: stented versus non-stented. The ureteroneocystostomy was made by anterior extravesical technique in all cases as Lich et al described. The stent was removed endoscopically after 2 to 4 weeks after transplantation if there were no surgical problems. All episodes of urinary tract infection, urinary leaks, urinary stricture, prolonged discharge by suction drain, hospital day and stent related problems were analysed. RESULTS: The overall major surgical complication rates in non-stented and stented groups were 5.9% (3 of 51) and 3.4% (1 of 29), respectively. In non-stented group, two ureteral leakages and one ureteral stricture developed. Two ureteral leakages were required reoperation in immediate postoperative period. But only one patient in stented group had symptomatic lymphocele requiring surgical correction (laparoscopic fenestration).Hospital stay was much shorter in stented group (23.0+/-5.4 days vs 31.3+/-9.3 days; P<.05). The timing of removal of suction drain is much faster in stented group (11.1+/-6.7 days vs 22.8+/-8.0 days; P<.05). There was no case of stent-related obstruction, stone formation and stent migration. There was no graft loss or mortality due to urological complications. CONCLUSION: The routine use of a double-J stent is recommendable in all recipients in order to prevent ureteral complications after renal transplantation.
Cadaver ; Constriction, Pathologic ; Humans ; Kidney Transplantation* ; Living Donors ; Lymphocele ; Mortality ; Postoperative Period ; Reoperation ; Retrospective Studies ; Stents* ; Suction ; Transplants ; Ureter* ; Urinary Tract Infections

PURPOSE: Kidney transplantation is definite treatment in chronic renal failure (CRF). But CRF patients have contracted bladder due to disuse atrophy and fibrosis of bladder mucosa and muscle. Contracted bladder results in CRF itself and failure of transplantation. And this causes many difficulties in ureteroneocystostomy. So many authors suggest that preoperative bladder augmentations of contracted bladder (cystoplasty) using intestine increase success rate in kidney transplantation. But these methods have been usually studied in pediatric transplantation. Preoperative hydrostatic bladder dilatation is nonoperative treatment usually used in interstitial cystitis and hemorrhagic bladder tumor. METHODS: Since January 1996, we newly attempted pretransplant bladder augmentation using hydrostatic pressure in 22 CRF patients who had contracted bladder diagnosed through preoperative voiding cystourethrogram (VCUG). RESULTS: Pre-augmented average bladder volume was 87.7 mL (60~100 mL) and post-augmented bladder volume was 210.5 mL (100~250 mL). There was no complication associated with pretransplant bladder augmentation itself, and there was no transplanted kidney loss. CONCLUSION: These results suggest that pretransplant bladder augmentation using hydrostatic pressure be useful in kidney transplantation of CRF patient who had contracted bladder.
Cystitis, Interstitial ; Dilatation ; Fibrosis ; Humans ; Hydrostatic Pressure* ; Intestines ; Kidney ; Kidney Failure, Chronic* ; Kidney Transplantation ; Mucous Membrane ; Muscular Disorders, Atrophic ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: Although renal transplantation is the most effective treatment for end stage renal disease (ESRD), the incidence of malignant tumors due to long-term immunosuppression has been increasing. We experienced 9 cases of Kaposi's sarcoma (KS) after renal transplantation in our institution out of 2250 renal transplant recipients. KS is a rare mesenchymal tumor involving blood and lymphatic vessels. The oncogenesis by human herpesvirus 8 (HHV8) represent important condition for this tumor to develop. METHODS: Clinicopathologic features, treatment results, and prognosis of the 9 patients diagnosed with KS after renal transplantation were analyzed retrospectively. RESULTS: There were 6 male and 3 female patients. The mean age was 41.1 years. The average period until diagnosis of KS after renal transplantation was 60 months (range: 6 months~8 years). Clinical features were variable, but mostly presenting several red- purple papular and nodular tumors. Lesions were found in the lower extremities in 6 patients. Three patients presented with palpable lymph nodes in the neck and inguinal area without any skin lesions. Computed tomography showed diffusely enlarged showed an aggressive course. lymphnodes. Systemic involvement was found in 2 patients. Diagnosis was confirmed by histopathologic studies. Immunohistochemical stains for HHV8 were positive in all patients. Five patients showed regression of lesions after drastic reduction of immunosuppression, local resection and/or radiotherapy. But other 4 patients resistant to therapy. CONCLUSION: KS is a rare tumor and appears to be caused primarily by HHV8 in Korea as well. Reduction or cessation of immunosuppression potentially improves symptoms, but it also increases the risk of chronic graft rejection or graft failure. A large-scale study, accumulating data from transplantation cases in Korea, to understand the relationship between the various types of immunosuppression and KS, and to set guidelines for treatment appears to be necessary in the future.
Carcinogenesis ; Coloring Agents ; Diagnosis ; Female ; Graft Rejection ; Herpesvirus 8, Human ; Humans ; Immunosuppression ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation* ; Korea ; Lower Extremity ; Lymph Nodes ; Lymphatic Vessels ; Male ; Neck ; Prognosis ; Radiotherapy ; Retrospective Studies ; Sarcoma, Kaposi* ; Skin ; Transplantation ; Transplants

PURPOSE: Over the several decades, there has been a considerable improvement in the survival of patients who undergo renal transplantation due to newer immunosuppressive agents and development of surgical technique and post-operative management. However, life expectancy beyond 10 years is still considerably less than that in the general population. We studied the causes of patient death after kidney transplantation to determine the major causes of death, to decrease the mortality rate of patient and to increase the graft survival rate. METHODS: From Jan. 1990 to Dec. 2002, 1353 renal transplantation were performed at Asan Medical Center. There had been 63 cases of patient death and we reviewed the causes of death, recipient-donor relationship, immunosuppressive agents, history of rejection and the time of death after transplantation in these patients, retrospectively. RESULTS: The major causes of patient death were infection (36.5%), cardiovascular disease (14.3%), malignancy (9.5%), hepatic failure (11.1%), miscellaneous (11.1%) and unknown (22.2%). Thirty-nine (61%) of total death occurred in the first year of transplantation and major cause in first year of transplants was infection (46.2%). Of 63 deaths, 35(55.6%) were with graft function and 49 (77.8%) had history of rejection. The patients with brain- death donor had a higher death rate than that of the patients with living donors (3.7% vs 7.8%, P=0.002). The patients who had history of rejection have higher death rate than the patient with no history of rejection (22.6% vs 1.3%, P<0.001). CONCLUSION: Active efforts for the prevention of rejection and infection in early phase of transplantation and close surveillance of malignancy and cardiovascular disease in long-term follow up will decrease the death of transplanted patients and increase the graft survival rate.
Cardiovascular Diseases ; Cause of Death* ; Chungcheongnam-do ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Kidney* ; Life Expectancy ; Liver Failure ; Living Donors ; Mortality ; Retrospective Studies ; Tissue Donors ; Transplants

PURPOSE: Cardiovascular disease is a substantial health problem in renal transplant patients, and ischemic heart disease is a leading cause of death in these patients. Renal transplant patients have many conventional risk factors for atherosclerotic coronary artery diaese, including hypertension, hyperlipidemia, and posttransplant diabetes mellitus. This study were to evaluate the prevalence of angiographically-determined coronary artery occlusive disease (CAOD) in renal transplant patients, and to identify the risk factors for significant coronary artery disease. METHODS: The retrospective study were performed in 36 patients with renal transplantation who underwent coronary angiography to diagnose ischemic heart disease. RESULTS: A total of 36 recipients (27 males, 9 females) were studied and the mean age was 51.5 years. Significant CAOD was identified in 69% of patients (1-vessel: 19%, 2: 25, 3: 25). By univariate and multivariate logistic regression analysis, the association of clinical variables with CAOD was assessed. The interval between the diagnosis of end-stage renl disease and renaltransplantation was an independent risk factor (P<0.05). The variables such as old age, acute rejection episodes, cholesterol level, as well as the presence of obesity, and D.M,. were not associated. CONCLUSION: The prevalence of angiographically-determined CAOD in renal transplant recipients is 69%. The risk of CAOD seems to be increased in recipients with long duration of dialysis before transplantation. The early or preemptive transplantation could be recommended for preventing CAOD in renal transplantation candidates.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Diabetes Mellitus ; Diagnosis ; Dialysis ; Humans ; Hyperlipidemias ; Hypertension ; Kidney Transplantation ; Logistic Models ; Male ; Myocardial Ischemia* ; Obesity ; Prevalence ; Retrospective Studies ; Risk Factors* ; Transplantation