Successful Kidney Transplantation in a Patient with Multiple Perioperative Renal Transplant Complications. Case Report

Abstract Kidney transplantations have become common surgical procedures that are associated with high success rates. Nevertheless, the detection, accurate diagnosis and timely management of the perioperative surgical complications sometimes require multidisciplinary team approach for some of the complications may result in significant morbidity, risk of graft loss and/or mortality of the recipient. A case of a 24-year old male patient that developed a number of different surgical complications is reported. The complications included venous graft thrombosis, urinary fistula, wound infection, wound dehiscence and a completely exteriorized transplanted kidney. Despite the various complications and, accordingly, a couple of revisions, finally the patient was discharged with a regular kidney function.

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Treatment of emergency surgical complications of kidney transplantations

Acta chirurgica iugoslavica ◽

10.2298/aci0702091d ◽

2007 ◽

Vol 54 (2) ◽

pp. 91-94 ◽

Cited By ~ 1

Author(s):

Z. Dzamic ◽

M. Acimovic ◽

C. Tulic ◽

D. Basic ◽

D. Milutinovic ◽

...

Keyword(s):

Surgical Complications ◽

Graft Loss ◽

Vascular Complications ◽

Kidney Graft ◽

Urinary Fistulas ◽

Massive Gastrointestinal Hemorrhage ◽

Kidney Transplantations ◽

Arterial Stenoses ◽

Iliac Artery Rupture ◽

Vesico Ureteral Reflux

Surgical complications subsequent to the kidney transplantation are not infrequent and they are characterized by the high percentage of graft loss (596-18% in standard surgical procedures and up to 37% in atypically performed transplantations). The study included 311 transplanted patients (206 (66.2%) living donors and 105 (33.8%) cadaver donors). Surgical complications developing during the immediate posttransplantation period as well as during the late period (after a year and a half) were classified as: I urinary complications; II vascular complications; III other complications. In majority of the cases urinary complications (urinary fistulas, ureteral obstructions, vesico-ureteral reflux) as well as other complications (cholecystopancreatitis and lymphocele) did not necessitate urgent treatment, unlike most of the vascular complications. All the vascular complications (29/311) developed during the immediate postoperative period, except for occurrence of arterial stenoses which ensued later on, while the development of symptoms was rapid. Severity of both symptoms and clinical picture necessitated urgent surgical re-intervention in order to preserve the graft and patient?s life. Vascular complications were classified as: true vascular complications, hemorrhages and kidney ruptures in order to distinguish technical and other factors contributing to development of the complications. Onset of the true vascular complications related to the graft and recipient blood vessel changes was evidenced in 20 patients (69%/29 patients) while the incidence of hemorrhages and ruptures was considerably lower (14%/29 patients and 17%/29 patients). As for the true vascular complications, vascular stem thrombosis subsequent to cadaveric transplantations was the most frequent, and transplantectomy was performed in all the cases in absence of any lethal outcomes. Two cases with iliac artery rupture resulted in graft loss subsequent to urgen exploration. In all cases with hemorrhages the applied therapy resulted in positive responses, except in one case in which massive gastrointestinal hemorrhage led to lethal outcome. The response to the urgent surgical treatment of spontaneous kidney graft ruptures was positive in 60% of the cases, while in the remaining 40% transplantectomy was necessitated due to the extensiveness of the lesion in order to preserve patient?s life. .

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1623: Percutaneous Interventions in Renal Transplant Complications

The Journal of Urology ◽

10.1016/s0022-5347(18)35745-8 ◽

2005 ◽

Vol 173 (4S) ◽

pp. 439-440

Author(s):

Erich Lang ◽

Raju Thomas ◽

Rodney Davis ◽

S. Florman ◽

Erik P. Castle ◽

...

Keyword(s):

Renal Transplant ◽

Percutaneous Interventions ◽

Transplant Complications ◽

Renal Transplant Complications

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Clinical impact of serum bilirubin levels on kidney transplant outcomes

Scientific Reports ◽

10.1038/s41598-021-86330-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Juhan Lee ◽

Eun Jin Kim ◽

Jae Geun Lee ◽

Beom Seok Kim ◽

Kyu Ha Huh ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Failure ◽

Serum Bilirubin ◽

Graft Loss ◽

Multivariable Analysis ◽

Post Transplantation ◽

Transplant Outcomes ◽

Increased Risk ◽

All Cause Mortality ◽

Kidney Transplantations

AbstractSerum bilirubin, a potent endogenous antioxidant, has been associated with decreased risks of cardiovascular disease, diabetes, and kidney disease. However, the effects of serum bilirubin on kidney transplant outcomes remain undetermined. We analyzed 1628 patients who underwent kidney transplantations between 2003 and 2017. Patients were grouped into sex-specific quartiles according to mean serum bilirubin levels, 3–12 months post-transplantation. Median bilirubin levels were 0.66 mg/dL in males and 0.60 mg/dL in females. The intra-individual variability of serum bilirubin levels was low (9%). Serum bilirubin levels were inversely associated with graft loss, death-censored graft failure, and all-cause mortality, independent of renal function, donor status, and transplant characteristics. Multivariable analysis revealed that the lowest serum bilirubin quartile was associated with increased risk of graft loss (HR 2.64, 95% CI 1.67–4.18, P < 0.001), death-censored graft failure (HR 2.97, 95% CI 1.63–5.42, P < 0.001), and all-cause mortality (HR 2.07, 95% CI 1.01–4.22, P = 0.046). Patients with lower serum bilirubin were also at greater risk of rejection and exhibited consistently lower glomerular filtration rates than those with higher serum bilirubin. Serum bilirubin levels were significantly associated with transplantation outcomes, suggesting that bilirubin could represent a therapeutic target for improving long-term transplant outcomes.

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Clinical and histological sequelae of surgical complications in horizontal guided bone regeneration: a systematic review and proposal for management

International Journal of Implant Dentistry ◽

10.1186/s40729-020-00274-y ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

John Rong Hao Tay ◽

Xiaotong Jacinta Lu ◽

Wei Ming Clement Lai ◽

Jia-Hui Fu

Keyword(s):

Bone Regeneration ◽

Surgical Complications ◽

Wound Dehiscence ◽

Guided Bone Regeneration ◽

Cochrane Central Register ◽

Weighted Mean ◽

Recipient Site ◽

Barrier Membrane ◽

Incidence Proportion ◽

Level Analysis

AbstractIt is not uncommon to encounter post-surgical complications after horizontal guided bone regeneration (GBR). The primary aim of this review was to evaluate the incidence and types of complications that occur after horizontal GBR and propose management strategies to deal with these clinical situations. A secondary aim was to conduct a histomorphometric review of the wound healing process at sites that experienced post-surgical complications after GBR. A keyword search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published in English from January 2015 to January 2020 was conducted for the primary aim and 23 studies were selected. A second search addressing the secondary aim was conducted, and five studies were included. Site-level analysis showed that the weighted mean incidence proportion of minor wound dehiscence and minor infections occurring at the augmented site was 9.9% [95% CI 6.4, 13.9, P < 0.01] and 1.5% [95% CI 0.4, 3.1, P = 0.21) respectively. Patient-level analysis showed minor and major complications occurring at a weighted mean incidence proportion of 16.1% [95% CI 11.9, 20.8, P = 0.01] and 1.6% [95% CI 0.0, 4.7, P < 0.01] respectively, while neurosensory alterations at the donor site was 7.0% [95% CI 1.3, 15.5, P < 0.01]. Subgroup analysis also revealed that the use of block grafts increased the incidence proportion of minor post-surgical complications, whereas a staged GBR procedure increased the incidence proportion of both minor and major post-surgical complications. Although exposure of the barrier membrane is often associated with less bone regeneration and graft resorption, the type of membrane used (resorbable or non-resorbable) had no statistically significant influence on any post-surgical complication. Histologically, a layer of fibrous connective tissue instead of bone is commonly observed at the interface between the native bone at the recipient site and the regenerated bone in cases with membrane exposure after GBR procedure. Minor wound dehiscence was the highest incidence proportion of post-surgical complications. Methods ranging from daily application of antiseptics, use of systemic antimicrobials, regular reviews, and total removal of the non-integrated biomaterials are commonly prescribed to manage these post-surgical complications in attempt to minimise the loss of tissue at the surgical site.

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Hemorheologic factors and post renal transplant complications

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-1987-7507 ◽

2016 ◽

Vol 7 (5) ◽

pp. 707-713

Author(s):

C. Berling ◽

C. Lacombe ◽

J.C. Lelievre

Keyword(s):

Renal Transplant ◽

Transplant Complications ◽

Renal Transplant Complications

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Sonographic evaluation of renal transplant complications

Journal of Medical Imaging and Radiation Oncology ◽

10.1111/j.1754-9485.2010.02161.x ◽

2010 ◽

Vol 54 (3) ◽

pp. 211-218 ◽

Cited By ~ 6

Author(s):

T Sutherland ◽

F Temple ◽

S Chang ◽

O Hennessy ◽

W-K Lee

Keyword(s):

Renal Transplant ◽

Sonographic Evaluation ◽

Transplant Complications ◽

Renal Transplant Complications

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Role of Ayurved in the Management of Wound Dehiscence - A Case Report

International Journal of Ayurvedic Medicine ◽

10.47552/ijam.v12i3.1915 ◽

2021 ◽

Vol 12 (2) ◽

pp. 395-397

Author(s):

Kiran Pundlikrao Mendhekar ◽

Sanjay Babar ◽

Ashwin Shete

Keyword(s):

Case Report ◽

Hospital Stay ◽

Surgical Procedure ◽

Fluid Collection ◽

Fatal Outcome ◽

Wound Dehiscence ◽

Wound Management ◽

Invasive Technique ◽

Team Approach ◽

Obese People

Wound dehiscence is the common problem which is faced by most of the surgeons in case of obese people. As we know, in case of post-operative wound management, avascularity and excessive adipose tissue lysis can lead to fluid collection which leads to gapping of sutured wound. This may also cause Dushta vrana i.e. secondary infection to the wound. Wound dehiscence in surgical field leads to most fatal outcome which can lead to cause local as well as systemic sepsis in the patient. Present case report reveals a treatment modality which involves multidisciplinary team approach such as management of wound as well as obesity by using Ayurvedic perspective. Whereas modern technique of resuturing the gapped wound exposes patient to another surgical procedure which is expensive and increases the hospital stay. The local and oral drugs formulations were proven effective in reducing excessive wound discharge as well as they stimulate the wound healing mechanism when administered in both local and systemic ways. The cost and benefit ratio was found high as there is no re-exposure to the surgical procedure and patient will get benefitted with non-invasive technique along with minimal expenses and hospital stay.

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