Diabetes Mellitus ; surgery ; Humans ; Kidney Transplantation ; adverse effects ; methods ; trends ; Organ Preservation ; methods ; trends ; Pancreas Transplantation ; adverse effects ; methods ; trends ; Renal Insufficiency ; surgery

BACKGROUNDSimultaneous liver and kidney transplantation (SLKT) has been proven to be a favorable treatment for combined renal and hepatic end-stage disease. However, recipients receiving SLKT have a long medical history, poor general condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalance and acid-base disorders. This study aimed to explore the indications, surgical techniques, therapeutic experience, prevention and treatment of postoperative complications of SLKT.

METHODSThe clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2008 were retrospectively studied. Indications for SLKT, surgical techniques, perioperative fluid management, immunosuppressive regimen and experience in prevention and treatment of postoperative complications were analyzed.

RESULTSAll operations were successfully performed. Postoperative complications occurred in 13 cases (59.1%), including pleural effusions (7), intra-abdominal bleeding (2), biliary complications (2), repeated upper gastrointestinal bleeding (1), and acute liver graft rejection (1). All complications were treated conservatively. In this study, there were five deaths during follow-up, in which three perioperative deaths occurred due to serious conditions. Mortality at 3 months was 13.6%. The one and three year patient survival rate was 81.3% and 73.9% respectively.

CONCLUSIONSSLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage to renal function. It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and more postoperative complications. The SLKT surgical techniques selected are based on the experience of surgeons, the anatomy of the recipient and primary diseases. It is essential to use the correct perioperative fluid management, reasonable immunosuppressive regimen, and prevention and treatment of postoperative infections, to improve the long-term patient survival after SLKT.

Adolescent ; Adult ; Child ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Transplantation ; adverse effects ; methods ; mortality ; Liver Transplantation ; adverse effects ; methods ; mortality ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Young Adult

BACKGROUNDMore patients receive organ transplantation surgeries due to the advancement in immunosuppressive agents and surgical techniques. Some of those patients may need to undergo plastic or reconstructive surgery. Long-term use of immunosuppressive agents raises some serious problems. Therefore, this study aimed to introduce our experience about the safety and effectiveness of plastic surgeries after solid organ allograft transplantation.

METHODSA retrospective review of 17 transplant recipients who underwent different reconstructive or cosmetic operations was carried out. The subjects included 1 heart transplant, 1 liver transplant and 15 kidney transplant recipients.

RESULTSAll patients tolerated the plastic surgery procedures well. Flaps and skin grafts were the main constructive methods. There were no postoperative infections and wound dehiscence. Transferred flaps survived completely. Skin grafts took well. Three of the cosmetic surgery patients were satisfied with the results.

CONCLUSIONSImmunosuppressed organ transplant recipients can successfully undergo major reconstructive and cosmetic surgery when given special attention.

Adolescent ; Adult ; Female ; Heart Transplantation ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Liver Transplantation ; Male ; Middle Aged ; Organ Transplantation ; Surgery, Plastic ; adverse effects ; methods ; Young Adult

PURPOSE: Although there is no clinical evidence of nephrotoxicity with the volatile anesthetics currently used in general anesthesia, a better agent should be needed in terms of preserving postoperative renal function in living kidney donors who have only single remaining kidney. The purpose of the current retrospective, single-center study was to evaluate and compare renal function of living kidney donors after nephrectomy under either sevoflurane or desflurane anesthesia. MATERIALS AND METHODS: From January 2006 through December 2011, a total of 228 donors undergoing video assisted minilaparotomy surgery nephrectomy for kidney donation were retrospectively enrolled in the current study. The donors were categorized into a sevoflurane group or desflurane group based on the type of volatile anesthetic used. We collected laboratory data from the patients preoperatively, immediately after the operation, on the first postoperative day and on the third postoperative day. We also compared renal function of the kidney donors after donor nephrectomy by comparing creatinine level and estimated glomerular filtration rate (eGFR). RESULTS: The decrease in renal function after surgery in both groups was the most prominent on the first postoperative day. There were no significant differences between the two groups in postoperative changes of creatinine or eGFR. CONCLUSION: Sevoflurane and desflurane can be used safely as volatile anesthetics in donors undergoing nephrectomy.
Adult ; Anesthesia, General/methods ; Anesthetics, Inhalation/adverse effects/*therapeutic use ; Female ; Humans ; Isoflurane/adverse effects/*analogs & derivatives/therapeutic use ; Kidney/*physiology ; Kidney Function Tests ; *Kidney Transplantation ; *Living Donors ; Male ; Methyl Ethers/adverse effects/*therapeutic use ; *Nephrectomy ; Postoperative Complications ; Retrospective Studies

BACKGROUNDRecently, the most common incision for kidney transplantation (KT) is an inverted J-shaped incision known as the "hockey-stick." However, demands for minimally invasive surgery in KT are increasing as in other various fields of surgery. Hence, we evaluated whether there is difference between minimal skin incision technique in kidney transplantation (MIKT) and conventional KT (CKT) .

METHODSBetween June 2006 and March 2013, a total of 452 living kidney transplant patients were enrolled. The MIKT group included 17 young unmarried women whose body mass index was <25 kg/m2 and had no anatomic variation. The CKT group included 435 patients. The MIKT operation technique restricted to the 10 cm-sized skin incision in the lower right abdomen from laterally below the anterior superior iliac spine to the midline just above the pubis was performed. We compared the baseline clinical characteristics and postoperative results between two groups. For proper comparison, propensity score matching was implemented.

RESULTSThere was no difference in graft function, survival, and postoperative complication rate between MIKT and CKT groups (all P > 0.05). The 5-year graft survival was 92.3% and 85.7% in MIKT and CKT groups, respectively (P = 0.786).

CONCLUSIONSOur results indicated that MIKT showed more favorable cosmetic results, and there were no statistical differences in various postoperative factors including graft function, survival, and complications compared with CKT. Hence, we suggested that MIKT is an appropriate method for selected patients in living KT.

Adult ; Female ; Humans ; Kidney Transplantation ; adverse effects ; methods ; mortality ; Living Donors ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies

Along with the wide application of cadaveric donor kidney transplantation (CDKT), most transplantation centers face the shortage of cadaveric donors. Living donor kidney transplantation (LDKT) has been successfully applied with remarkable advantages over CDKT. Human leukocyte antigen matching generally is not an important problem in non-related LDKT. Even with 6-locus mismatch, the effectiveness of LDKT is still superior to non-mismatch CDKT. Although LDKT donor has extremely low mortality and incidence of complications, the safety of LDKT donor is becoming a research highlight. In addition, many social problems are involved in LDKT, which should be deliberately considered during clinical practice.
Adolescent ; Adult ; Aged ; Graft Survival ; immunology ; Humans ; Kidney Transplantation ; adverse effects ; ethics ; methods ; psychology ; Living Donors ; Middle Aged ; Young Adult

OBJECTIVETo study the treatment technique for harvesting injury of donor blood vessels for the clinic application.

METHODSThe data of 32 renal transplantation patients with injury of graft blood vessels were retrospectively reviewed. 60 renal transplantation patients with non-injury during the same term were selected as the control group. The treatment techniques for harvesting injury of graft blood vessels mainly includes end-to-end anastomosis of graft artery, side-to-side anastomosis of branch artery, end-to-side anastomosis of branch artery to the main renal artery, reconstruction of multiple segmental arteries by using iliac arterial grafts from cadaveric donors or recipients on the workbench, repairs of injuries for the smaller segmental/polar arteries by using inferior epigastric artery, end-to-end anastomosis of the lower thick segmental/polar arteries with the iliac internal arterial by placing kidney upside down.

RESULTSThose injured included 28 arterial and 4 venous. Average bench surgery time was 42 minutes. Mean warm ischemic time was 31 minutes. No death occurred at an average follow-up of 3.5 years (1 - 5 years). There was no statistical difference in the 1-year graft survival, postoperative 1-year acute rejection, delayed graft function (DGF) and the incidence of constriction of vascular anastomosis rate (96.9%, 12.5%, 21.9%, 3.1%, respectively) compared with non-reconstructed kidneys during the same term (98.3%, 11.7%, 18.3%, 1.7%, P > 0.05, respectively).

CONCLUSIONThe flexible and appropriate application of different vascular reconstruction means and satisfactory surgery techniques play an important role in assuring quality of kidney with harvesting blood vessels injury and donor kidney availability.

Adolescent ; Adult ; Anastomosis, Surgical ; Female ; Humans ; Kidney ; blood supply ; surgery ; Kidney Transplantation ; methods ; Male ; Microsurgery ; Nephrectomy ; adverse effects ; Renal Artery ; injuries ; surgery ; Renal Veins ; injuries ; surgery ; Retrospective Studies ; Tissue Donors ; Tissue and Organ Harvesting ; adverse effects ; Transplantation, Homologous

OBJECTIVETo evaluate the effects of different CO(2) pneumoperitoneum conditions on renal function in rats and provide experimental evidence for improving renal graft function after transplantation.

METHODSSD rats were randomized into 10 groups (n=12) and subject to CO(2) pneumoperitoneum at different pressures (0.67, 1.33 and 2.0 kPa) for 60 or 120 min. Serum urea nitrogen (BUN), creatinine (Cr) and N-acetyl-β-D-glocosaminidase (NAG) levels were detected after pneumoperitoneum.

RESULTSAs the pressure and time of pneumoperitoneum increased, the renal function deteriorated gradually, showing significant differences between the groups (P<0.05).

CONCLUSIONIncreased pressure and prolonged duration of CO(2) pneumoperitoneum causes impairment of the renal function, suggesting the necessity of reducing the operative time and lowering the pressure of pneumoperitoneum when harvesting renal graft in living donors.

Animals ; Carbon Dioxide ; Female ; Kidney ; physiology ; Kidney Transplantation ; Laparoscopy ; methods ; Male ; Nephrectomy ; methods ; Pneumoperitoneum, Artificial ; adverse effects ; methods ; Rats ; Rats, Sprague-Dawley ; Retroperitoneal Space ; surgery ; Time Factors ; Tissue and Organ Harvesting ; methods

BACKGROUNDCytomegalovirus (CMV) remains a significant clinical problem among immunosuppressed renal transplant patients. Quantitative PCR assays have become the most common methods in the determination of CMV infections in transplant patients. This study was to determine the relationship between CMV infection and the acute rejection of the transplanted kidney.

METHODSPlasma samples from 77 renal transplant patients that were pre-transplant negative for CMV infection were tested using real-time quantitative PCR and CMV gene-specific primers. The detected viral loads were retrospectively compared with the acute rejection rate and the chronic or mild rejection rates of the renal transplant.

RESULTSCMV-DNA was detected in 29 of 77 recipients, yielding a positive rate of detection of 37.7% for this procedure. Twelve of the 21 recipients (57.1%) who suffered acute rejection had positive CMV-DNA. Among the 56 recipients suffered from chronic or mild rejection, 17 (30.4%) had positive CMV-DNA plasma. Moreover, of the 29 recipients who had detectable CMV-DNA after transplant, 12 (41.4%) suffered from acute rejection; of the 48 recipients with undetectable CMV-DNA, only nine (18.8%) developed acute rejection. Post-transplant patients with acute rejection had a higher rate (57.1% vs. 30.4%, P = 0.03) of post-transplant CMV infection than those with chronic or mild rejection.

CONCLUSIONCMV infection is a risk factor of acute renal transplant rejection and CMV infection should be prevented and treated in renal transplant recipients.

Adult ; Cytomegalovirus Infections ; diagnosis ; genetics ; DNA, Viral ; genetics ; Female ; Humans ; Kidney Transplantation ; adverse effects ; Male ; Middle Aged ; Real-Time Polymerase Chain Reaction ; methods ; Viral Load ; Young Adult

Background: Hypothermic machine perfusion (HMP) is being used more often in cardiac death kidney transplantation; however, the significance of assessing organ quality and predicting delayed graft function (DGF) by HMP parameters is still controversial. Therefore, we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment. Methods: From September 1, 2012 to August 31, 2016, 366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution. The HMP variables of the development cohort served as candidate univariate predictors for DGF. The independent predictors of DGF were identified by multivariate logistic regression analysis with a P < 0.05. According to the odds ratios (ORs) value, each HMP variable was assigned a weighted integer, and the sum of the integers indicated the total risk score for each kidney. The validation cohort was used to verify the accuracy and reliability of the scoring model. Results: HMP duration (OR = 1.165, 95% confidence interval [CI]: 1.008-1.360, P = 0.043), resistance (OR = 2.190, 95% CI: 1.032-10.20, P < 0.001), and flow rate (OR = 0.931, 95% CI: 0.894-0.967, P = 0.011) were the independent predictors of identified DGF. The HMP predictive score ranged from 0 to 14, and there was a clear increase in the incidence of DGF, from the low predictive score group to the very high predictive score group. We formed four increasingly serious risk categories (scores 0-3, 4-7, 8-11, and 12-14) according to the frequency associated with the different risk scores of DGF. The HMP predictive score indicates good discriminative power with a c-statistic of 0.706 in the validation cohort, and it had significantly better prediction value for DGF compared to both terminal flow (P = 0.012) and resistance (P = 0.006). Conclusion The HMP predictive score is a good noninvasive tool for assessing the quality of DCD kidneys, and it is potentially useful for physicians in making optimal decisions about the organs donated.
Adult ; Delayed Graft Function ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; adverse effects ; methods ; Logistic Models ; Male ; Multivariate Analysis ; Odds Ratio ; Organ Preservation