Anticoagulants ; therapeutic use ; Child ; Humans ; Kidney Transplantation ; methods ; mortality ; Prognosis

OBJECTIVETo summarize the treatment experience of long-term surviving patients after combined abdominal organ transplantation.

METHODSFrom October 2001 to January 2005, 19 patients received combined abdominal organ transplantation in Nanfang Hospital, including 6 with simultaneous kidney-pancreas transplantation (SKPT), 12 with combined liver-kidney transplantation (CLKT), and 1 with simultaneous liver-pancreas transplantation (SLPT). The periods of follow up were from 6 months to 3 years and 8 months. Summarize primary diseases of the patients, factors which impacted on patients long-term survival rate, and immunological characteristics of combined abdominal organ transplantation.

RESULTSAll of 19 transplant cases were performed successfully. Among then, 18 were followed up; 16 survived till now; 2 patients undergoing liver-kidney transplantation were dead, one of which died from myocardial infarction in the 18 months after operation, and one died from cytomegalovirus in infection of lung in 13 months; 1 liver-kidney transplantation patient and 2 pancreas-liver transplantation patients experienced acute rejection once; 2 patients were found nephrotoxicity. Among the 18 patients, 4 patients' survival time were over 3 years, 7 over 2 years, 6 over 1 year, 1 over 10 months.

CONCLUSIONSCombined abdominal organ transplantation is effective for treatment of two abdominal organ failure diseases. Factors which impact on patients long-term surviving include choosing suitable recipient, high quality of donated organ, avoidance of surgical complication, the history of myocardial infarction before operation, immunosuppressive regime and virus infection late after transplantation. Combined abdominal organ transplantation has some different immunological characteristics from single organ transplantation.

Adult ; Aged ; Duodenum ; transplantation ; Female ; Follow-Up Studies ; Humans ; Kidney Transplantation ; immunology ; methods ; mortality ; Liver Transplantation ; immunology ; methods ; mortality ; Male ; Middle Aged ; Pancreas Transplantation ; immunology ; methods ; mortality ; Treatment Outcome

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

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

OBJECTIVETo analyze the preoperative risk factors on liver transplant recipients with acute renal failure(ARF), and to evaluate renal replacement therapy (RRT) as a transitonary therapy before liver transplantation.

METHODSLiver transplant recipients with acute renal failure treated with renal replacement therapy between January 1st, 2001 and January 1st, 2008 in our center were retrospected. Clinical characteristics, the kinds of RRT and prognosis were analyzed; Logistic regression was applied to analyze the parameters that can forecast the motality of the liver transplant recipients with acute renal failure.

RESULTSOf the patients who received RRT, 30% survived to liver transplantation, 67.5% died while waiting for liver transplantation. The dead had a higher multiple organ dysfunction score (MODS), and lower mean arterial pressure than those survived to liver transplantation. There was no significant difference in the duration of RRT between continuous renal replacement therapy (CRRT) patients and hemodialysis patients. CRRT patients had a higher MODS, lower mean arterial pressure, lower serum creatinine than hemodialysis patients. Lower mean arterial pressure was statistically associated with higher risk of mortality.

CONCLUSIONThough mortality was high, RRT helps part (30%) of patients survive to liver transplantation. Therefore, considering the high mortality without transplantation, RRT is acceptable for liver transplant recipients with ARF.

Acute Kidney Injury ; etiology ; mortality ; therapy ; Adult ; Blood Pressure ; Female ; Humans ; Liver Transplantation ; adverse effects ; Liver, Artificial ; Male ; Middle Aged ; Prognosis ; Regression Analysis ; Renal Dialysis ; methods ; Renal Replacement Therapy ; mortality ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Survival Analysis

Kidney transplantation is the best therapeutic choice to improve survival and quality of life in patients with end-stage diabetic nephropathy. Long-term prognosis in diabetic patients who recevied kidney transplants, however, has not been delineated. We, therefore, studied patient and graft survival, graft function and cause of graft failure in 78 Type I diabetic kidney transplant recipients in The Rogosin Institute/The Weill-Cornell Medical Center, New York who had functioning grafts for more than one year. The results were compared with 78 non-diabetic patients who had functioning grafts for more than one year and were matched for age, gender, donor source, time of transplantation and immunosuppressive therapy protocol. Cumulative patient survival rates for diabetic patients were significantly lower than those of non-diabetic patients (86% vs. 97% at 5 years and 74% vs. 95% at 10 years, respectively; p<0.05). The most common cause of death was cardiovascular disease. Graft survival rates for diabetic patients were also lower than that of non- diabetic patients (71% vs. 80% at 5 years and 58% vs. 72% at 10 years, respectively), but the differences did not reach statistical significance. Among the 22 failed grafts in diabetic patients, 7 (32%) were due to patient death rather than primary graft failure. If the patients who died with a functioning graft were censored, graft survival rates of diabetic patients approached those of non-diabetic patients (80% vs. 81% at 5 years and 65% vs. 73% at 10 years, respectively). Creatinine clearances in diabetic patients were lower than that in non-diabetic patients through the follow-up period, but the differences were significant only for the first few years. At no time was there a higher creatinine clearance for diabetic patients. Among the 16 patients who had transplant kidney biopsies two to seven years post-transplant, 6 showed morphological changes consistent with diabetic nephropathy. One patient lost graft function solely by recurrent diabetic nephropathy. We conclude that long-term patient survival for diabetic patients is significantly lower than that of non-diabetic patients, due primarily to cardiovascular disease. Graft survival is comparable between the two groups. Creatinine clearances of diabetic patients are lower than those of non-diabetic patients. There is no apparent glomerular hyperfiltration at any time in diabetic patients. Recurrence of diabetic nephropathy is a rare cause of graft failure in the first 10 year post-transplant period. Aggressive intervention to modify cardiovascular risk factors should improve patient and graft survival in diabetic kidney transplant recipients.
Adult ; Case-Control Studies ; *Cause of Death ; Chi-Square Distribution ; Comparative Study ; Diabetes Mellitus, Insulin-Dependent/*complications ; Diabetic Nephropathies/etiology/*mortality/*surgery ; Female ; Graft Rejection ; Graft Survival ; Human ; Kidney Function Tests ; Kidney Transplantation/methods/*mortality ; Male ; Middle Age ; Probability ; Prognosis ; Risk Factors ; Survival Rate ; Time Factors

In order to evaluate whether immunosuppressive agents such as mycophenolate mofetil (MMF) and azathioprine would differently influence the outcome of the renal transplants, we prospectively analyzed the incidence of acute rejection episodes, cytomegalovirus infection within the first 6 months following renal transplantation and 5 yr graft survival rate after minimizing influences of donor factors by grafting the same cadaveric donor kidney. There was no significant difference in sex, HLA mismatch, cold ischemic time, and patients' weight between the two groups. Contrary to the previous studies which demonstrated that MMF could lower the incidence of acute rejection episodes and improved graft survival rate, the two groups showed no significant difference in the incidence of acute rejection episodes and 5-yr graft survival rate as well. This discrepancy in these results might explain that donor factors could be important to cadaveric renal transplantation. Thus, we suggest that the influences of donor factors should be considered in further clinical studies of cadaveric renal transplantation.
ABO Blood-Group System ; Adult ; Azathioprine/*pharmacology ; Body Weight ; Cadaver ; Cytomegalovirus/metabolism ; Cytomegalovirus Infections/metabolism ; Female ; Graft Rejection ; Graft Survival ; Histocompatibility Testing ; Humans ; Immunophenotyping ; Immunosuppressive Agents/pharmacology ; Ischemia ; Kidney Diseases/mortality/therapy ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Mycophenolic Acid/*analogs & derivatives/*pharmacology ; Prospective Studies ; Time Factors ; Tissue Donors ; Treatment Outcome