1
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Minkovich M, Gupta N, Liu M, Famure O, Li Y, Selzner M, Lee JY, Kim SJ, Ghanekar A. Impact of early surgical complications on kidney transplant outcomes. BMC Surg 2024; 24:165. [PMID: 38802757 PMCID: PMC11129490 DOI: 10.1186/s12893-024-02463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Kidney transplantation (KT) improves clinical outcomes of patients with end stage renal disease. Little has been reported on the impact of early post-operative surgical complications (SC) on long-term clinical outcomes following KT. We sought to determine the impact of vascular complications, urological complications, surgical site complications, and peri-graft collections within 30 days of transplantation on patient survival, graft function, and hospital readmissions. METHODS We conducted a single-centre, observational cohort study examining adult patients (≥ 18 years) who received a kidney transplant from living and deceased donors between January 1st, 2005 and December 31st, 2015 with follow-up until December 31st, 2016 (n = 1,334). Univariable and multivariable analyses were performed with Cox proportional hazards models to analyze the outcomes of SC in the early post-operative period after KT. RESULTS The cumulative probability of SC within 30 days of transplant was 25%, the most common SC being peri-graft collections (66.8%). Multivariable analyses showed significant relationships between Clavien Grade 1 SC and death with graft function (HR 1.78 [95% CI: 1.11, 2.86]), and between Clavien Grades 3 to 4 and hospital readmissions (HR 1.95 [95% CI: 1.37, 2.77]). CONCLUSIONS Early SC following KT are common and have a significant influence on long-term patient outcomes.
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Affiliation(s)
- Michelle Minkovich
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Nikita Gupta
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Michelle Liu
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Olusegun Famure
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Yanhong Li
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
| | - Markus Selzner
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
- Division of General Surgery, University Health Network, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Jason Y Lee
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
- Division of Urology, University Health Network, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - S Joseph Kim
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada
- Division of Nephrology, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Anand Ghanekar
- Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 9-MaRS-9050, Toronto, ON, M5G 2N2, Canada.
- Division of General Surgery, University Health Network, Toronto, Canada.
- Department of Surgery, University of Toronto, Toronto, Canada.
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Kumar M, Ram Dhayal I. Observational Study of Early Outcomes in Single-Vessel and Multiple-Vessel Renal Allograft. Cureus 2022; 14:e27579. [PMID: 36059293 PMCID: PMC9428421 DOI: 10.7759/cureus.27579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/05/2022] Open
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Sigdel PR, Gnyawali D, Thapa J, Rai BDK, Dhital P, Parajuli P, Chudal S, Pradhan M, Poudyal S, Chapagain S, Luitel BR, Chalise PR, Gyawali PR, Sharma UK. Bipolar vessel sealing system versus silk ligation of lymphatic vessels in renal transplant recipient lymphatic complications: a randomized controlled trial. Int Urol Nephrol 2021; 53:2477-2483. [PMID: 34655393 DOI: 10.1007/s11255-021-03003-5] [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: 08/06/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study was aimed to compare lymphatic complications of bipolar vessel sealing system with silk ligation of lymphatic vessels among renal transplant recipients. METHODS This was a prospective randomized controlled trial done among 68 patients undergoing renal transplantation in Tribhuvan University Teaching Hospital. They were randomly assigned to either silk ligation or Enseal bipolar vessel sealing lymphatic dissection. Postoperative drain volume and duration of drain placement were measured in all patients. Ultrasound was used to find lymphocele formation in six and 12 weeks. RESULTS Total of 30 patients in silk ligation group and 28 patients in bipolar vessel sealing group were analyzed. The baseline characteristics of the patients in each group were similar. Overall, lymphatic complications (either lymphorrhea or lymphocele formation) were in 16 cases (27.58%), 7 (25%) in the bipolar group, and 9 (30%) in the silk ligation group (p = 0.67). A total of 13 patients (22.41%) had lymphorrhea, 6 (21.4%) patients in the bipolar group, and 7 (23.3%) patients in the silk ligation group. Median drain volume was 415 ml (Q1 275 ml, Q3 675 ml) in the bipolar group and 542 ml (Q1 290, Q3 775) in silk group (p = 0.72). Median drain removal day was 5 in each bipolar and silk group with Q1 and Q3 being 5 days in each arm (p = 0.95). A total of five patients (8.62%) developed symptomatic lymphocele, two (7.1%) in the bipolar group, and three (10%) in the silk ligation group, but the difference was not statistically significant. In univariate analysis, double renal arteries in the donor's kidney (p = 0.03) and graft rejection (p = 0.04) were risk factors for the development of lymphatic complications. However, in multivariable analysis, these factors were not statistically significant. CONCLUSIONS This study did not find any significant differences in lymphatic complications between bipolar vessel sealing system and silk ligation. However, large sample multi-centric studies should be done to add evidences on lymphatic complications differences between these two techniques. TRIAL REGISTRATION NUMBER UMIN000039354, Date of registration-2020, Feb 01.
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Affiliation(s)
- Prem Raj Sigdel
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
| | - Diwas Gnyawali
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Jeevan Thapa
- Department of Community Health Sciences, Patan Academy of Health Sciences, Patan, Nepal
| | - Bipendra D K Rai
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pawan Dhital
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Purushottam Parajuli
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sampanna Chudal
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Manish Pradhan
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sujeet Poudyal
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Suman Chapagain
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhoj R Luitel
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pawan R Chalise
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Prem R Gyawali
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Uttam K Sharma
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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4
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Scheuermann U, Rademacher S, Wagner T, Lederer A, Hau HM, Seehofer D, Sucher R. Influence of Multiple Donor Renal Arteries on the Outcome and Graft Survival in Deceased Donor Kidney Transplantation. J Clin Med 2021; 10:jcm10194395. [PMID: 34640413 PMCID: PMC8509629 DOI: 10.3390/jcm10194395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023] Open
Abstract
AIM Complex arterial reconstruction in kidney transplantation (KT) using kidneys from deceased donors (DD) warrants additional study since little is known about the effects on the mid- and long-term outcome and graft survival. METHODS A total of 451 patients receiving deceased donor KT in our department between 1993 and 2017 were included in our study. Patients were divided into three groups according to the number of arteries and anastomosis: (A) 1 renal artery, 1 arterial anastomosis (N = 369); (B) >1 renal artery, 1 arterial anastomosis (N = 47); and (C) >1 renal artery, >1 arterial anastomosis (N = 35). Furthermore, the influence of localization of the arterial anastomosis (common iliac artery (CIA), versus non-CIA) was analyzed. Clinicopathological characteristics, outcome, and graft and patient survival of all groups were compared retrospectively. RESULTS With growing vascular complexity, the time of warm ischemia increased significantly (groups A, B, and C: 40 ± 19 min, 45 ± 19 min, and 50 ± 17 min, respectively; p = 0.006). Furthermore, the duration of operation was prolonged, although this did not reach significance (groups A, B, and C: 175 ± 98 min, 180 ± 35 min, and 210 ± 43 min, respectively; p = 0.352). There were no significant differences regarding surgical complications, post-transplant kidney function (delayed graft function, initial non-function, episodes of acute rejection), or long-term graft survival. Regarding the localization of the arterial anastomosis, non-CIA was an independent prognostic factor for deep vein thrombosis in multivariate analysis (CIA versus non-CIA: OR 11.551; 95% CI, 1.218-109.554; p = 0.033). CONCLUSION Multiple-donor renal arteries should not be considered a contraindication to deceased KT, as morbidity rates and long-term outcomes seem to be comparable with grafts with single arteries and less complex anastomoses.
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Affiliation(s)
- Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
- Correspondence:
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Tristan Wagner
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Münster, Germany
| | - Andri Lederer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Hans-Michael Hau
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl-Gustav-Carus, TU Dresden, 01307 Dresden, Germany;
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (S.R.); (T.W.); (A.L.); (D.S.); (R.S.)
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5
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Alomar OSK. Comparison between single and multiple renal vessels in live donor allograft kidney transplantation: Surgical aspects and outcomes, 25 years experience. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mok S, Park YJ, Park SC, Yun SS. Efficacy of Lymphatic Sealing Using the LigaSure in Kidney Transplantation: A Pilot Study. Transplant Proc 2021; 53:2278-2284. [PMID: 34404537 DOI: 10.1016/j.transproceed.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Iliac vessel lymphatic ligation is critical in kidney transplantation, because it is associated with the occurrence of lymphocele. Lymphocele can also affect the renal graft. This study aimed to evaluate the efficacy of lymphatic sealing using LigaSure (an electrothermal bipolar sealing device) in kidney transplantation as compared with conventional silk-tie ligation. METHODS This retrospective study included 100 consecutive patients from a prospectively registered database who underwent kidney transplantation at Seoul St. Mary's Hospital, South Korea, between December 1, 2019 and November 12, 2020. Comorbidities, primary renal disease, transplantation variables, surgical variables, and posttransplantation outcomes were compared between conventional and LigaSure lymphatic ligations. Subgroup analyses were performed by anastomosis pattern. RESULTS The mean age of patients was 47.4 ± 12.40 (range, 24-73) years. The LigaSure and conventional groups comprised 50 (50%) patients. Hypertension history, number of anastomosed renal arteries, and anastomosis patterns differed significantly between groups (P < .05). No significant difference was found in postoperative outcomes. In the subgroup analysis, greater drain volume was found at postoperative day 1 in the end-to-end internal iliac artery-renal artery anastomosis group (P = .001) because the internal iliac artery dissection results in longer lymphatic ligation. Nevertheless, no differences in drain removal time (P = .528) or lymphocele incidence were found between subgroups. CONCLUSION LigaSure is expected to benefit from surgery time and will be identified in subsequent studies. LigaSure can be safely and comfortably used for iliac lymphatic ligation in kidney transplantation. In conclusion, LigaSure lymphatic ligation is superior to conventional lymphatic ligation in kidney transplantation.
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Affiliation(s)
- Sangkyun Mok
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Jun Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Sang Seob Yun
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Mahajan AD, Patel ND, Singh Pal L, Bathe S, Darakh PP, Patil M. Retrospective Analysis of the Comparison Between Single Renal Artery Versus Multiple Renal Arteries in Living Donor Kidney Transplant: Does It Affect the Outcome? EXP CLIN TRANSPLANT 2020; 19:38-43. [PMID: 33272157 DOI: 10.6002/ect.2020.0244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES There is an increased risk of vascular complications in kidney transplant for allografts with multiple renal arteries versus a single renal artery. We compared the clinical outcomes of living donor kidney transplant recipients who received allografts with a single renal artery versus multiple renal arteries. MATERIALS AND METHODS This retrospective analysis included all living-related donor kidney transplants that were performed by a single skilled urologist. All donor nephrectomies were performed by open method. The left kidney was preferred over the right for donor nephrectomy, except in cases of vascular problems or other contraindications, for which the right kidney was preferred. In most of the cases, kidneys were placed in the right iliac fossa for transplant by an extraperitoneal approach. RESULTS Of 97 living donor kidney transplants, 82 had a single renal artery (group 1) and 15 had multiple renal arteries (group 2). Patients ranged in age from 18 to 76 years old. Recipient ages (33.00 vs 29.46 years) and baseline serum creatinine values (8.61 vs 8.82 mg/dL) were comparable in groups 1 and 2 (P > .05). However, mean operative time and total ischemia time were significantly higher in the multiple renal artery group (221 and 53.45 minutes, respectively) compared with the single renal artery group (202 and 77.6 minutes, respectively). Graft survival at 1 year was 95.12% in the single renal artery group and 93.33% in the multiple renal artery group. Patient survival at 1 year was 96.34% in the single renal artery group and 93.33% in the multiple renal artery group. CONCLUSIONS The safety of kidney transplants of allografts with multiple renal arteries is equal to the safety of transplants of allografts with a single renal artery in terms of vascular complications and acute tubular necrosis, as well as patient and graft survival.
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Affiliation(s)
- Abhay Dinkar Mahajan
- From the Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
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Lim EJ, Aslim EJ, Lee FJ, Gan VHL. Intranodal lymphangio-embolisation as treatment for lymphocele after kidney transplantation: A case report. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820960189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction and objectives: The rate of symptomatic lymphoceles requiring intervention after renal transplantation is reported to be only 5.6%. Controversies prevail in the current literature regarding the management of symptomatic lymphoceles post renal transplantation, with no established algorithm. The creation of a peritoneal window, frequently performed laparoscopically, is deemed the gold standard for management. We herin report the case of a lymphocele post renal transplant treated minimally invasively with intranodal lymphangio-embolisation, with a review of the current literature of this uncommon procedure. Methods: This was a retrospective review of this patient’s electronic medical records. Results: We present a 43-year-old male with end-stage kidney disease secondary to chronic glomerulonephritis, having been on hemodialysis for seven years. He underwent a deceased donor dual kidney transplant, complicated postoperatively by renal vein thrombosis in one of the grafts, resulting in early graft nephrectomy as well as a distal ureterovesical leak requiring reimplantation. On re-implantation on postoperative day 16, he was noted to have a persistent high drain ouput with a normal drain fluid creatinine. A right intranodal lymphagiogram was performed, and this demonstrated an active lymph leak around the transplanted kidney. A 33% glue (N-butyl cyanoacrylate)-Lipodiol infusion was then injected at a rate of 0.2 mL/min intranodally under fluoroscopic guidance. The patient underwent another repeat embolisation five days later for a residual lymph leak with satisfactory results. Drain output subsequently decreased, and the drain was removed. Conclusions: This case suggests that intranodal lymphangiography and embolisation may not only be a diagnostic tool but can be considered as an effective, minimally invasive and safe method for the treatment of lymphoceles after kidney transplantation.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | | | - Fang Jann Lee
- Department of Urology, Singapore General Hospital, Singapore
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Sevmis M, Demir ME, Merhametsiz O, Aktas S, Sevmis S, Uyar M. Grafts With Multiple Renal Arteries in Kidney Transplantation. Transplant Proc 2020; 53:933-940. [PMID: 32950261 DOI: 10.1016/j.transproceed.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/21/2020] [Accepted: 07/11/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Renal grafts with multiple renal arteries (MRA) are a compelling issue in surgery of kidney transplantation. Transplantations using "grafts with MRA" have conflicting results. Here, we present our experiences on the issue. METHOD This is a single-center, observational, descriptive study. One hundred ninety-nine patients with end-stage renal disease received a kidney graft from their living- or deceased-related donors in our center between July 2016 and May 2017. We included all recipients to the study. Patients were divided into the following 2 groups: Group 1, recipients who received a renal graft with single renal artery, and Group 2, recipients who received a renal graft with MRA. Groups were compared for estimated glomerular filtration rates (months 1-3 and 12), delayed graft function, and graft survival. Data were analyzed by using SPSS for Windows version 15. RESULTS One hundred ninety-five recipients with all documented data were analyzed. Graft function was compared between 2 groups in months 1, 3, and 12 and found both to have similar outcomes. MRA has been indicated to have no impact on delayed graft function, higher risk for vascular injury, and biopsy-proven acute tubular necrosis. Also, anastomosis sides have been found to have no importance on graft function in recipients with MRA (P > .05 between all sides). CONCLUSION Our study indicates grafts with MRA and grafts with a single renal artery have comparable results in the first post-transplant year.
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Affiliation(s)
- Murat Sevmis
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Mehmet Emin Demir
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey.
| | - Ozgur Merhametsiz
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey
| | - Sema Aktas
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Sinasi Sevmis
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Murathan Uyar
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey
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10
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Dogan SM, Dogan G, Simsek C, Okut G, Berktas B, Simsek A, Kutluturk K, Taskapan H, Sahin I, Sahin TT, Piskin T, Uslu A. Transplantation Using Renal Grafts With Multiple Renal Arteries: A Putative Study on the Impact of Arterial Reconstruction Technique and Site of Implantation on Outcomes. Transplant Proc 2020; 53:920-926. [PMID: 32919803 DOI: 10.1016/j.transproceed.2020.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/07/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the present retrospective study, we analyzed the outcomes of patients transplanted with grafts with multiple renal arteries (MRAs). PATIENTS AND METHODS In total, 89 patients were transplanted with renal grafts with MRAs from 2003 to 2018. Demographic characteristics; type of donor; warm and cold ischemia times; arterial anastomosis technique; complications; graft function at first month, first year, and last outpatient clinic visit; and patient and graft survival were all retrospectively evaluated. RESULTS The mean age of the patients was 40.4 ± 13.3 years. Fifty-six patients (62.9%) were male. In total, 42 patients (47.2%) received renal grafts from living related donors. In group A (n = 24; 27%), anastomosis was performed separately to the recipient external or internal iliac arteries; in group B (n = 38; 42.7%), the secondary artery was anastomosed to the main artery in a side-to-side fashion to form a single common orifice; in group C (n = 27; 30.3%), secondary arteries were anastomosed to the main renal artery in an end-to-side fashion. Creatinine clearance at the first month was significantly lower for deceased-donor grafts compared to living-donor renal grafts (P < .05). Creatinine clearance in the first postoperative month was significantly lower in group A and creatinine clearance in the first year was significantly lower in group C (P < .05). The best survival was found for anastomosis to the internal iliac artery (P < .05). CONCLUSION MRAs can be safely used and the reconstruction technique does not matter if the graft kidney's arterial supply is preserved and the internal iliac artery is chosen for anastomosis.
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Affiliation(s)
- Sait M Dogan
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Gulec Dogan
- Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cenk Simsek
- Department of Surgery, Izmir Bozyaka Teaching Hospital, Izmir, Turkey
| | - Gokalp Okut
- Department of Surgery, Izmir Bozyaka Teaching Hospital, Izmir, Turkey
| | - Bayram Berktas
- Department of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Arife Simsek
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Koray Kutluturk
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Hulya Taskapan
- Department of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Idris Sahin
- Department of Nephrology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Turgut Piskin
- Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adam Uslu
- Department of Surgery, Izmir Bozyaka Teaching Hospital, Izmir, Turkey
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11
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Mehrabi A, Kulu Y, Sabagh M, Khajeh E, Mohammadi S, Ghamarnejad O, Golriz M, Morath C, Bechstein WO, Berlakovich GA, Demartines N, Duran M, Fischer L, Gürke L, Klempnauer J, Königsrainer A, Lang H, Neumann UP, Pascher A, Paul A, Pisarski P, Pratschke J, Schneeberger S, Settmacher U, Viebahn R, Wirth M, Wullich B, Zeier M, Büchler MW. Consensus on definition and severity grading of lymphatic complications after kidney transplantation. Br J Surg 2020; 107:801-811. [PMID: 32227483 DOI: 10.1002/bjs.11587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - S Mohammadi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - G A Berlakovich
- Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - N Demartines
- Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland
| | - M Duran
- Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - L Fischer
- Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - L Gürke
- Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland
| | - J Klempnauer
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany
| | - A Pascher
- Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - P Pisarski
- Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany
| | - J Pratschke
- Department of Surgery, Charité University Hospital, Berlin, Germany
| | - S Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - R Viebahn
- Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany
| | - M Wirth
- Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - M Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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12
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Kumar A, Panwar P, Bansal D, Maheshwari R, Chaturvedi S, Desai P. Management of donor kidneys with double renal arteries with significant luminal discrepancy: A retrospective cohort study. Indian J Urol 2020; 36:200-204. [PMID: 33082635 PMCID: PMC7531379 DOI: 10.4103/iju.iju_196_20] [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: 04/19/2020] [Revised: 05/04/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: Side-to-side pantaloon anastomosis for renal grafts with double renal arteries (RA) with significant luminal discrepancy between graft arteries has not been reported. We hypothesized that the pantaloon technique is feasible and safe in these cases. Materials and Methods: A retrospective review of all consecutive, open, live-related renal transplants with double RA with significant luminal discrepancy performed at our center from January 2014 to September 2018 was undertaken. Significant luminal discrepancy was defined as smaller RA constituting 30% ± 5% of total RA diameter on preoperative computed tomography angiogram. Three groups were defined: Group A - pantaloon anastomosis, Group B - end-to-side anastomosis of smaller to main RA, and Group C - separate implantation of each artery. The primary objective was to study feasibility and safety of pantaloon anastomosis measured by recipient serum creatinine levels, Doppler ultrasound, and vascular complications (vascular thrombosis and anastomotic bleed). Secondary objectives included measurement of cold ischemia time, warm ischemia time in recipient (WIR), and nonvascular recipient complications. Results: Fifty-eight recipients had donors with double RA with significant luminal discrepancy. Group A - included 40, Group B – 5, and Group C - 13 patients. Recipient creatinine at day-7, - 30, and - 90 were similar among the groups. The 30-day perioperative complication rate was also similar. Group A and B had significantly lower WIR and higher cold ischemia time compared to Group C. Conclusion: Pantaloon anastomosis is feasible in renal grafts with double RA with significant luminal discrepancy and offers advantage of lower WIR compared to separate implantation technique.
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Giovanardi F, Nudo F, Lai Q, Garofalo M, Consolo A, Choppin De Janvry E, Arroyo Murillo GA, Ursi P, Stabile D, Melandro F, Berloco PB, Pretagostini R, Poli L. Surgical Technique Notes of Arterial Vascular Reconstruction During Kidney Transplantation: Personal Experience and Literature Review. Transplant Proc 2018; 51:128-131. [PMID: 30661896 DOI: 10.1016/j.transproceed.2018.04.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arterial vascular anomalies in patients undergoing kidney transplantation (KT) are correlated with a higher incidence of early surgical complications, potentially causing graft loss. Arterial reconstruction allows patients to overcome these surgical challenges, thus minimizing the risk of poor outcomes. The aim of the present study is to retrospectively investigate the safety and effectiveness of the multiple arterial reconstruction technique with a Teflon patch in case of an unavailable aortic patch: to do so, surgical complications, graft function, and patient survival were evaluated. METHODS During the period January 2009 to August 2016, 202 adult deceased-donor KTs were performed at our center. Group A (n = 27; reconstruction of multiple arteries) and Group B (n = 175; control group) were compared. RESULTS No differences were observed between the 2 groups in terms of early postoperative course, with no vascular complication observed in Group A. No vascular patch infections were reported, nor longer cold ischemia time rates. Similarly, long-term survival rates were similar between the 2 groups. CONCLUSIONS The Teflon-patch arterial reconstruction technique appears to be safe and effective, with an acceptable balance of benefits and potential risks of using a prosthetic material. Studies based on larger series are needed to further validate this approach.
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Affiliation(s)
- F Giovanardi
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - F Nudo
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Q Lai
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - M Garofalo
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - A Consolo
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - E Choppin De Janvry
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - G A Arroyo Murillo
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - P Ursi
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - D Stabile
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - F Melandro
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - P B Berloco
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - R Pretagostini
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy.
| | - L Poli
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
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Gulas E, Wysiadecki G, Szymański J, Majos A, Stefańczyk L, Topol M, Polguj M. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries. Arch Med Sci 2018; 14:442-453. [PMID: 29593819 PMCID: PMC5868651 DOI: 10.5114/aoms.2015.55203] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/16/2015] [Indexed: 11/17/2022] Open
Abstract
Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.
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Affiliation(s)
- Ewelina Gulas
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Jacek Szymański
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Lodz, Lodz, Poland
| | | | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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Wijayaratne DR, Sudusinghe DH, Gunawansa N. Multiple Renal Arteries in Live Donor Renal Transplantation; Impact on Graft Function and Outcome: A Prospective Cohort Study. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojots.2018.81001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Lucan CV, Jurchis I, Suciu M, Selicean SE, Buttice S. Modern lymphatic dissection techniques for preventing post renal transplant lymphocele. Med Pharm Rep 2017; 90:416-419. [PMID: 29151791 PMCID: PMC5683832 DOI: 10.15386/cjmed-716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/12/2016] [Indexed: 12/23/2022] Open
Abstract
Background and aims Development of a lymphocele is a well-known complication following kidney transplant. Among causative factors, recipient iliac lymphatics dissection plays an important role. Electrothermal bipolar sealing devices (LigaSureTM) have been shown to decrease lymphatic leakage in a number of instances. The aim of this study was to investigate whether the use of this device decreases post-operative lymphatic complications in kidney transplant. Methods 48 patients admitted for renal transplant were included in the study. They were randomly assigned to either conventional ligation or LigaSureTM during lymphatic dissection. Results One patient in the LigaSureTM arm and 5 patients in the conventional ligation arm developed lymphocele (p=0.04). Lymphatic drainage volumes were 99.8±39.87 ml in the LigaSure arm and 131.46±54.2 ml in the conventional ligation arm (p=0.02). Conclusion Electrothermal bipolar sealing devices exhibit safety and efficiency when used in renal transplant lymphatic dissection. In the present study, this technique proved to be superior to conventional ligation in terms of post-operative lymphatic complications.
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Affiliation(s)
- Ciprian Valerian Lucan
- Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ionut Jurchis
- Department of Urology, St. Ioan County Hospital, Suceava, Romania
| | - Mihai Suciu
- Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania.,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Salvatore Buttice
- Department of Urology, Messina University Hospital; Hospital Clinic Barcelona, Italy
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17
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Budgeon C, Hardie RJ, McAnulty JF. A Carrel patch technique for renal transplantation in cats. Vet Surg 2017; 46:1139-1144. [DOI: 10.1111/vsu.12705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/31/2017] [Accepted: 04/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Casey Budgeon
- Department of Surgical Sciences; University of Wisconsin-Madison; Madison Wisconsin
| | - Robert J. Hardie
- Department of Surgical Sciences; University of Wisconsin-Madison; Madison Wisconsin
| | - Jonathan F. McAnulty
- Department of Surgical Sciences; University of Wisconsin-Madison; Madison Wisconsin
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18
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Cases C, García-Zoghby L, Manzorro P, Valderrama-Canales FJ, Muñoz M, Vidal M, Simón C, Sanudo JR, McHanwell S, Arrazola J. Anatomical variations of the renal arteries: Cadaveric and radiologic study, review of the literature, and proposal of a new classification of clinical interest. Ann Anat 2017; 211:61-68. [PMID: 28163208 DOI: 10.1016/j.aanat.2017.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyse the variations of the renal arteries in two samples, cadaveric and computerized tomographic (CT) images, as well as to propose a simple classification of such variations based on the obtained results and an extensive review of the literature on the topic. MATERIAL AND METHODS Sixty human dissected kidneys and their vessels, and 583 abdominal CT were studied. RESULTS A total of 86 arteries were described in the cadaveric sample, whereas 1223 were analysed in the radiological one. Five types (a-e) and patterns (I-V) have been stablished in the classification. Type a, aortic hilar artery, incidences were 79% in cadavers and 95% in CT; Type b, hilar upper polar artery, incidences were 10% in cadavers and 2% in CT; Type c, aortic upper polar artery, incidences were 5% in cadavers and 2% in CT; Type d, aortic lower polar artery, incidences were 3% in cadavers and 1% in CT; Type e, hilar lower polar artery, incidences were 2% in cadaver and less than 0.1% in CT. The pattern represents the number of arteries reaching one kidney. Patterns I-IV were found in cadavers (I: 78%; II: 19%; III and IV: 2%); in CT sample only patterns I (88%) and II (12%). Pattern V was added because it has been described in the reviewed literature. CONCLUSIONS Type a and pattern I are the most prevalent, both in the cadaveric and the CT samples. Also in the consulted literature. There are no differences in the types and pattern incidences by side or sex. A simple, comprehensive and useful classification is proposed.
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Affiliation(s)
- Clara Cases
- Department of Human Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Spain
| | - Laura García-Zoghby
- Department of Human Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Spain
| | - Paula Manzorro
- Department of Human Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Spain
| | - Francisco J Valderrama-Canales
- Department of Human Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Spain; Corpses Donation Centre, Complutense University of Madrid, Spain.
| | - Miguel Muñoz
- Department of Radiology, University Hospital Clínico San Carlos, Madrid, Spain
| | - María Vidal
- Department of Radiology, University Hospital Clínico San Carlos, Madrid, Spain
| | - Clara Simón
- Department of Computer Science and Statistics, Rey Juan Carlos University, Madrid, Spain
| | - Jose R Sanudo
- Department of Human Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, Spain
| | - Stephen McHanwell
- School of Medical Education and School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Juan Arrazola
- Department of Radiology, University Hospital Clínico San Carlos, Madrid, Spain
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Treatment of the Lymphocele After Kidney Transplantation: A Single-center Experience. Transplant Proc 2016; 48:1637-40. [DOI: 10.1016/j.transproceed.2016.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/27/2016] [Accepted: 03/30/2016] [Indexed: 11/22/2022]
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20
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Hiramitsu T, Futamura K, Okada M, Yamamoto T, Tsujita M, Goto N, Narumi S, Watarai Y, Kobayashi T. Impact of Arterial Reconstruction With Recipient's Own Internal Iliac Artery for Multiple Graft Arteries on Living Donor Kidney Transplantation: Strobe Study. Medicine (Baltimore) 2015; 94:e1811. [PMID: 26512578 PMCID: PMC4985392 DOI: 10.1097/md.0000000000001811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to investigate the usefulness of arterial reconstruction using the recipient's own internal iliac artery for multiple kidney graft arteries.The safety and efficacy of various arterial reconstruction methods have been demonstrated. Although some reports have documented arterial reconstruction with the recipient's own internal iliac artery for multiple kidney graft arteries using the interposition method, usefulness of this technique has not yet been investigated compared with other arterial reconstruction methods.Between January 2008 and April 2014, 532 living donor kidney transplants in adult recipients were performed at 1 center. Of these, 389 kidney grafts had a single artery and did not need arterial reconstruction (nonarterial reconstruction group). Among the bench surgery patients, 19 kidney grafts for multiple arteries were performed using the interposition method with the recipient's own internal iliac artery (interposition group). Seventy-nine kidney grafts were performed using conjoined reconstruction (conjoined group) and 15 kidney grafts were performed using end-to-side reconstruction (end-to-side group). Total ischemic time (the period between arterial clamp and blood reperfusion), time to initial urination, perioperative and postoperative estimated glomerular filtration rate (eGFR), and complication rates between the interposition group and other 3 groups were retrospectively investigated. This study was based on the STROBE compliant.Warm ischemic time (the period between arterial clamp and beginning of the cold perfusion) of interposition group was significantly longer than that of nonarterial reconstruction group. Total ischemic time of the interposition group was significantly longer than those of other 3 groups. But time to initial urination, perioperative and postoperative eGFR, and complications were similar to other 3 groups.The interposition method was shown to be a useful standard method for multiple kidney graft arteries of living donor kidney transplantation in carefully selected recipients without calcification of the iliac arteries.
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Affiliation(s)
- Takahisa Hiramitsu
- From the Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital (TH, KF, MO, TY, MT, NG, SN, YW); and Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan (TK)
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Ranghino A, Segoloni GP, Lasaponara F, Biancone L. Lymphatic disorders after renal transplantation: new insights for an old complication. Clin Kidney J 2015; 8:615-22. [PMID: 26413290 PMCID: PMC4581383 DOI: 10.1093/ckj/sfv064] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/29/2015] [Indexed: 12/29/2022] Open
Abstract
In renal transplanted patients, lymphoceles and lymphorrhea are well-known lymphatic complications. Surgical damage of the lymphatics of the graft during the procurement and of the lymphatic around the iliac vessels of the recipients has been associated with development of lymphatic complications. However, lymphatic complications may be related to medical factors such as diabetes, obesity, blood coagulation abnormalities, anticoagulation prophylaxis, high dose of diuretics, delay in graft function and immunosuppressive drugs. Consistently, immunosuppression regimens based on the use of mTOR inhibitors, especially in association with steroids and immediately after transplantation, has been associated with a high risk to develop lymphocele or lymphorrhea. In addition, several studies have demonstrated the association between rejection episodes and lymphatic complications. However, before the discovery of reliable markers of lymphatic vessels, the pathogenic mechanisms underlining the development of lymphatic complications during rejection and the influence of mTOR inhibitors remained not fully understood. The recent findings on the lymphatic systems of either native or transplanted kidneys together with the advances achieved on lymphangiogenesis shared some lights on the pathogenesis of lymphatic complications after renal transplantation. In this review, we describe the surgical and medical causes of lymphatic complications focusing on the rejection and immunosuppressive drugs as causes of lymphatic complications.
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Affiliation(s)
- Andrea Ranghino
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Giuseppe Paolo Segoloni
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
| | - Fedele Lasaponara
- Division of Urology , Città della Salute e della Scienza Hospital , Torino , Italy
| | - Luigi Biancone
- Renal Transplantation Center 'A. Vercellone', Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences , Città della Salute e della Scienza Hospital and University of Torino , Torino , Italy
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22
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An institutional based study of post-operative surgical complications of live related renal transplant recipients. INDIAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.1016/j.ijt.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bozkurt B, Koçak H, Dumlu E, Mesci A, Bahadir V, Tokaç M, Hamidioğlu N, Ertuğ Z, Süleymanlar G, Dinçkan A. Favorable Outcome of Renal Grafts With Multiple Arteries: A Series of 198 Patients. Transplant Proc 2013; 45:901-3. [DOI: 10.1016/j.transproceed.2013.02.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Identification of risk factors for vascular thrombosis may reduce early renal graft loss: a review of recent literature. J Transplant 2012; 2012:793461. [PMID: 22701162 PMCID: PMC3369524 DOI: 10.1155/2012/793461] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/08/2012] [Indexed: 12/17/2022] Open
Abstract
Renal graft survival has improved over the past years, mainly owing to better immunosuppression. Vascular thrombosis, though rare, therefore accounts for up to one third of early graft loss. We assess current literature on transplantation, identify thrombosis risk factors, and discuss means of avoiding thrombotic events and saving thrombosed grafts. The incidence of arterial thrombosis was reported to 0.2–7.5% and venous thrombosis 0.1–8.2%, with the highest incidence among children and infants, and the lowest in living donor reports. The most significant risk factors for developing thrombosis were donor-age below 6 or above 60 years, or recipient-age below 5-6 years, per- or postoperative hemodynamic instability, peritoneal dialysis, diabetic nephropathy, a history of thrombosis, deceased donor, or >24 hours cold ischemia. Multiple arteries were not a risk factor, and a right kidney graft was most often reported not to be. Given the thrombosed kidney graft is diagnosed in time, salvage is possible by urgent reoperation and thrombectomy. Despite meticulous attentions to reduce thrombotic risk factors, thrombosis cannot be entirely prevented and means to an early detection of this complication is desirable in order to save the kidneys through prompt reoperation. Microdialysis may be a new tool for this.
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Mersa B, Gürkan A, Özçelik B, Kaçar S, Varılsüha C, Turunç V, Baş S, Server S. Anastomosis of Accessory Arteries Via Microsurgical Technique in Renal Transplantation. Transplant Proc 2011; 43:819-21. [DOI: 10.1016/j.transproceed.2011.01.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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The Application of the Iliac Artery in the Ex Vivo Reconstruction of Renal Arteries in Renal Transplantation. Transplantation 2010; 89:1113-6. [DOI: 10.1097/tp.0b013e3181d54b8e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dimitroulis D, Bokos J, Zavos G, Nikiteas N, Karidis NP, Katsaronis P, Kostakis A. Vascular complications in renal transplantation: a single-center experience in 1367 renal transplantations and review of the literature. Transplant Proc 2009; 41:1609-14. [PMID: 19545690 DOI: 10.1016/j.transproceed.2009.02.077] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Accepted: 02/09/2009] [Indexed: 02/06/2023]
Abstract
Renal transplantation is the treatment of choice for end-stage renal disease. Vascular complications in renal transplantation are not uncommon and may often lead to allograft loss. The most common vascular complications are transplant renal artery stenosis, transplant renal artery thrombosis, transplant renal vein thrombosis, biopsy-induced vascular injuries, pseudoaneurysm formation, and hematomas. Transplant renal artery and vein thrombosis have an early onset and a dramatic clinical manifestation and usually lead to allograft loss. In contrast, transplant renal artery stenosis has better treatment possibilities, whereas the rest do not occur so often. In our institution, 1367 renal transplantations were performed from September 1980 to April 2005. During this period, we encountered 38 major vascular complications leading to graft loss and 19 transplant renal artery stenoses with successful treatment in the majority of cases. According to these data, we can conclude that renal transplantation is a safe therapeutic procedure for renal failure.
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Affiliation(s)
- D Dimitroulis
- Second Propaedeutic Department of Surgery, University of Athens, Medical School, Athens, Attiki, Greece
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Treatment of Vascular Complications After Kidney Transplantation. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Mehrabi A, Fonouni H, Wente M, Sadeghi M, Eisenbach C, Encke J, Schmied BM, Libicher M, Zeier M, Weitz J, Büchler MW, Schmidt J. Wound complications following kidney and liver transplantation. Clin Transplant 2007; 20 Suppl 17:97-110. [PMID: 17100709 DOI: 10.1111/j.1399-0012.2006.00608.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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Verhoest G, Salomon L, Barrou B, Bensalah K, Guille F, Lobel B, Petit J, Boutin JM, Descotes JL, Dore B, Staerman F, Benoit G, Badet L, Hubert J, Lechevallier E, Patard JJ. Enquête nationale prospective sur la qualité chirurgicale des greffons rénaux en France. Etude du Comité de Transplantation de l’Association Française d’Urologie. Prog Urol 2007; 17:54-9. [PMID: 17373238 DOI: 10.1016/s1166-7087(07)92226-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE The objective of this prospective study was to describe the nature of the lesions observed during brain-dead cadavre donor kidney harvesting in France and to identify the risk factors for these lesions. MATERIAL AND METHODS A questionnaire elaborated by the AFU Transplantation Committee concerning the quality of kidneys harvested from cadavre donors was sent to all centres performing renal transplantation in France in 2000. This prospective study was conducted over a period of 1 year and concerned the overall multi-organ harvesting procedure based on all data concerning the renal parenchyma, arteriovenous and ureteric characteristics, and the outcome of the transplants. RESULTS Twelve centres completed the survey, allowing analysis of the data of 201 donor kidneys. 91% of harvesting surgeons were urologists. Various incidents were reported during 11% of harvesting procedures, but 1/3 of the abnormalities were not recorded by the harvesting surgeon. Isolated kidney harvesting was found to be a risk factor (20% vs 8.6%). The rate of parenchymal abnormalities was 50%, 2/3 of which were related to inadequate removal of perirenal fat. Atheroma was a risk factor for arterial lesions during harvesting (21% vs 6.50). Venous abnormalities were detected in 9% of cases: 89% of them were due to the harvesting procedure and 59% of them were not identified by the harvesting surgeon. The fact of not being a transplant surgeon was a risk factor for venous lesions (21.9% vs 6.5%). 4% of ureteric lesions were observed with no consequence on graft outcome. CONCLUSION Adequate removal of perirenal fat before conditioning is not acquired. Isolated kidney harvesting and atheroma were risk factors for parenchymal and arterial lesions, respectively. Venous harvesting anomalies were more frequent among non-transplant surgeons.
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