Basic science and renal transplant

2019 ◽  
pp. 827-846
Author(s):  
John Reynard ◽  
Simon F Brewster ◽  
Suzanne Biers ◽  
Naomi Laura Neal
Keyword(s):  
Blood Flow ◽  
Renal Transplantation ◽  
Renal Replacement Therapy ◽  
Renal Transplant ◽  
Basic Science ◽  
Renal Physiology ◽  
Physiological Functions ◽  
Organ Rejection ◽  
Sodium And Potassium ◽  
Donor Transplant

This chapter covers the basic physiological functions of the kidney, bladder, and urethra. Renal anatomy is detailed, including the anatomical relations of the kidney. Renal physiology is covered in detail, including the regulation of renal blood flow and regulation of water, acid–base, sodium, and potassium balance. It includes the principles of renal replacement therapy and the principles of renal transplantation, including assessment of both the recipient and the donor. Transplant surgery is outlined, including commonly used drugs and complications and their management and common complications of renal transplant surgery. The different types of organ rejection are discussed, including their treatments.

Basic science and renal transplant

2013 ◽  
pp. 793-814
Author(s):  
John Reynard ◽  
Simon Brewster ◽  
Suzanne Biers
Keyword(s):  
Blood Flow ◽  
Renal Replacement Therapy ◽  
Renal Transplant ◽  
Water Balance ◽  
Basic Science ◽  
Renal Physiology ◽  
Potassium Excretion ◽  
Acid Base Balance ◽  
Base Balance ◽  
Sodium And Potassium

Basic physiology of bladder and urethra 794 Basic renal anatomy 796 Renal physiology: glomerular filtration and regulation of renal blood flow 800 Renal physiology: regulation of water balance 802 Renal physiology: regulation of sodium and potassium excretion 803 Renal physiology: acid–base balance 804 Renal replacement therapy ...

scholarly journals Verapamil improves the outcome after cadaver renal transplantation.

1991 ◽  
Vol 2 (5) ◽  
pp. 983-990
Author(s):  
I Dawidson ◽  
P Rooth ◽  
C Lu ◽  
A Sagalowsky ◽  
K Diller ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Oral Administration ◽  
Renal Artery ◽  
Graft Survival ◽  
Antilymphocyte Globulin ◽  
Acute Renal Dysfunction ◽  
Transplant Patients ◽  
Blood Flow Velocities

Because of their favorable effects on renal hemodynamics, calcium antagonists may have a major role in the prevention and management of certain types of acute renal dysfunction. In fact, verapamil (VP) was shown to prevent cyclosporin A (CsA)-induced decreases in RBF in mice and in cadaver renal transplant (CRT) recipients. The study presented here of 59 cadaver renal transplant patients evaluates the outcome from perioperative treatment with VP (N = 30) administered intraoperatively into the renal artery (10 mg) followed by oral administration of 120 mg every 8 to 12 h for 14 days versus no drug (N = 29). Early immunosuppression included azathioprine, corticosteroids, and antilymphocyte globulin with subsequent overlapping with CsA on days 5 and 6. Actuarial graft survival at 1 yr was different when the two groups were compared (P less than 0.05). Estimated graft survival at 1 yr for VP patients was 93.3 compared with 72.4% in control patients. The improved graft survival was most striking in repeat transplants with 90% graft survival at 1 yr for VP recipients versus 37.5% for controls. Compared with controls, VP recipients had significantly improved renal parenchymal diastolic blood flow velocities on the first day after surgery (7.8 versus 5.8 cm/s). By day 7, GFR were greater with VP (44 +/- 29 mL/min) versus controls (28 +/- 22 mL/min). Of VP patients, 67% (18 of 24) had GFR greater than 30 mL/min versus 33% (9 of 26) for control patients. Similarly, on the seventh day, 77% (21 of 30) of VP patients had serum creatinines less than 2.0 mg% versus 34% (10 of 29) for controls.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Robotic Versus Open Renal Transplantation in Obese Patients: Protocol for a Cost-Benefit Markov Model Analysis (Preprint)

2017 ◽  
Author(s):  
Michele Molinari ◽  
Chethan Puttarajappa ◽  
Martin Wijkstrom ◽  
Armando Ganoza ◽  
Roberto Lopez ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Renal Transplantation ◽  
Renal Replacement Therapy ◽  
Renal Transplant ◽  
Markov Model ◽  
Replacement Therapy ◽  
Controlled Trial ◽  
Cost Benefit ◽  
Obese Patients ◽  
Robotic Assisted

BACKGROUND Recent studies have reported a significant decrease in wound problems and hospital stay in obese patients undergoing renal transplantation by robotic-assisted minimally invasive techniques with no difference in graft function. OBJECTIVE Due to the lack of cost-benefit studies on the use of robotic-assisted renal transplantation versus open surgical procedure, the primary aim of our study is to develop a Markov model to analyze the cost-benefit of robotic surgery versus open traditional surgery in obese patients in need of a renal transplant. METHODS Electronic searches will be conducted to identify studies comparing open renal transplantation versus robotic-assisted renal transplantation. Costs associated with the two surgical techniques will incorporate the expenses of the resources used for the operations. A decision analysis model will be developed to simulate a randomized controlled trial comparing three interventional arms: (1) continuation of renal replacement therapy for patients who are considered non-suitable candidates for renal transplantation due to obesity, (2) transplant recipients undergoing open transplant surgery, and (3) transplant patients undergoing robotic-assisted renal transplantation. TreeAge Pro 2017 R1 TreeAge Software, Williamstown, MA, USA) will be used to create a Markov model and microsimulation will be used to compare costs and benefits for the two competing surgical interventions. RESULTS The model will simulate a randomized controlled trial of adult obese patients affected by end-stage renal disease undergoing renal transplantation. The absorbing state of the model will be patients' death from any cause. By choosing death as the absorbing state, we will be able simulate the population of renal transplant recipients from the day of their randomization to transplant surgery or continuation on renal replacement therapy to their death and perform sensitivity analysis around patients' age at the time of randomization to determine if age is a critical variable for cost-benefit analysis or cost-effectiveness analysis comparing renal replacement therapy, robotic-assisted surgery or open renal transplant surgery. After running the model, one of the three competing strategies will result as the most cost-beneficial or cost-effective under common circumstances. To assess the robustness of the results of the model, a multivariable probabilistic sensitivity analysis will be performed by modifying the mean values and confidence intervals of key parameters with the main intent of assessing if the winning strategy is sensitive to rigorous and plausible variations of those values. CONCLUSIONS After running the model, one of the three competing strategies will result as the most cost-beneficial or cost-effective under common circumstances. To assess the robustness of the results of the model, a multivariable probabilistic sensitivity analysis will be performed by modifying the mean values and confidence intervals of key parameters with the main intent of assessing if the winning strategy is sensitive to rigorous and plausible variations of those values.

scholarly journals Renal transplantation at the Singapore General Hospital: a miracle in the making over 50 years

2020 ◽  
Vol 29 (4) ◽  
pp. 245-251
Author(s):  
Terence Kee Yi Shern
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
General Hospital ◽  
Organ Transplant ◽  
Kidney Donation ◽  
Kidney Donor ◽  
Human Organ ◽  
Singapore General Hospital ◽  
Donor Transplant

Background: This paper documents the history of the renal transplant programme at Singapore General Hospital. Renal transplantation in Singapore was born out of a necessity to offer a cheaper alternative to the expensive and scarce dialysis treatments in the 1970s. As a result, the first deceased kidney donor transplant was performed in 1970 at what Singapore General Hospital was then called ‘the Outram General Hospital’. However, deceased donation rates were dismal and prompted the start of a living kidney donor transplant programme in 1976 at Singapore General Hospital. Unfortunately, the prevalent population of patients with end-stage renal failure rapidly grew while kidney donation rates remain poor despite active efforts to raise awareness and even importing unwanted kidneys from other countries. Discussion: As a result, an opting-out legislation called the Human Organ Transplant Act was introduced in 1987 and increased the rate of deceased kidney donor transplantation in Singapore. Over the next two decades, access to kidney transplantation was further expanded with the introduction of living unrelated kidney donor transplantation and laparoscopic donor nephrectomy. In the past 10 years, there have been further advances in kidney transplantation with the introduction of newer immunosuppressive agents and technologies to perform incompatible kidney transplantation. The Human Organ Transplant Act has also been amended to allow the use of older deceased donors and permit paired kidney donor exchanges. Conclusion: Despite these many advances, kidney donation rates remain low and are even declining. This would certainly be the major challenge for the renal transplant programme in the next 50 years to come.

scholarly journals Renal transplant surgery – Then and now

2020 ◽  
Vol 29 (4) ◽  
pp. 252-255
Author(s):  
Valerie Huei Li Gan
Keyword(s):  
Renal Transplantation ◽  
Renal Replacement Therapy ◽  
Renal Transplant ◽  
Replacement Therapy ◽  
General Hospital ◽  
Transplant Program ◽  
Singapore General Hospital ◽  
Look Back ◽  
Kidney Transplantations

This year, Singapore General Hospital celebrates 50 years of renal transplantation. As we commemorate this historic milestone, we look back at the surgical journey and remember the pioneers, local as well as international, who have overcome myriad hurdles in performing kidney transplantations. These visionary surgeons have worked hand in hand with our nephrologists to establish renal transplantation as the renal replacement therapy of choice and our hospital as the oldest transplant program in Singapore.

scholarly journals Small bowel obstruction due to retroperitoneal hernia following renal transplant: a case report

2020 ◽  
Vol 2020 (11) ◽  
Author(s):  
Atta Nawabi ◽  
Adam C Kahle ◽  
Clay D King ◽  
Perwaiz Nawabi
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Common Type ◽  
Postoperative Phase ◽  
Oral Contrast ◽  
Large Defect ◽  
Retroperitoneal Dissection ◽  
Unclear Etiology

Abstract Para duodenal hernias, the most common type of retroperitoneal hernias, are thought to occur naturally from abnormal gut rotation because of fusion folds within the peritoneum. Retroperitoneal hernias are a rare postoperative complication and have not been described after renal transplantation via a retroperitoneal approach. This case report presents a 48-year-old male with intestinal obstruction after renal transplant due to herniation into the retroperitoneum via an incidentally created peritoneal defect. We suggest computed tomography with oral contrast be used in the early postoperative phase to assess for obstruction in patients with prolonged ileus of unclear etiology who have undergone retroperitoneal dissection. Small peritoneal defects should be closed during dissection. Larger, or multiple peritoneal defects should be extended to make a single, large defect to decrease the possibility of bowel herniating and becoming incarcerated.

Bicêtre hospital experience with sirolimus-based therapy in human renal transplantation: the sirolimus European renal transplant study

2003 ◽  
Vol 35 (3) ◽  
pp. S58-S61 ◽  
Author(s):  
B Charpentier ◽  
C.G Groth ◽  
L Bäckman ◽  
J.-M Morales ◽  
R Calne ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Hospital Experience

scholarly journals Is There Decreasing Public Interest in Renal Transplantation? A Google TrendsTM Analysis

2020 ◽  
Vol 9 (4) ◽  
pp. 1048
Author(s):  
Andreas Kronbichler ◽  
Maria Effenberger ◽  
Jae Il Shin ◽  
Christian Koppelstätter ◽  
Sara Denicolò ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Public Interest ◽  
Public Awareness ◽  
Relative Reduction ◽  
Special Focus ◽  
Search Term ◽  
Search Queries

Background and objectives: Renal transplantation is the preferred form of renal replacement therapy for the majority of patients with end stage renal disease (ESRD). The Internet is a key tool for people seeking healthcare-related information. This current work explored the interest in kidney transplantation based on Internet search queries using Google TrendsTM. Design, setting, participants, and measurements: We performed a Google TrendsTM search with the search term “kidney transplantation” between 2004 (year of inception) and 2018. We retrieved and analyzed data on the worldwide trend as well as data from the United Network for Organ Sharing (UNOS), the Organización Nacional de Trasplantes (ONT), the Eurotransplant area, and the National Health Service (NHS) Transplant Register. Google TrendsTM indices were investigated and compared to the numbers of performed kidney transplants, which were extracted from the respective official websites of UNOS, ONT, Eurotransplant, and the NHS. Results: During an investigational period of 15 years, there was a significant decrease of the worldwide Google TrendsTM index from 76.3 to 25.4, corresponding to an absolute reduction of −50.9% and a relative reduction by −66.7%. The trend was even more pronounced for the UNOS area (−75.2%), while in the same time period the number of transplanted kidneys in the UNOS area increased by 21.9%. Events of public interest had an impact on the search queries in the year of occurrence, as shown by an increase in the Google TrendsTM index by 39.2% in the year 2005 in Austria when a person of public interest received his second live donor kidney transplant. Conclusions: This study indicates a decreased public interest in kidney transplantation. There is a clear need to raise public awareness, since transplantation represents the best form of renal replacement therapy for patients with ESRD. Information should be provided on social media, with a special focus on readability and equitable access, as well as on web pages.

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