scholarly journals Vascular Complications in Live Related Renal Transplant – BSMMU Experience

2020 ◽  
Vol 23 (1) ◽  
pp. 72-75
Author(s):  
Tohid Mohammad Saiful Hossain ◽  
Tahmina Karim ◽  
Md Habibur Rahman ◽  
AKM Khurshidul Alam ◽  
Abdul Matin Anamur Rashid Choudhury
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Artery ◽  
Surgical Complication ◽  
Graft Loss ◽  
Vascular Complications ◽  
Artery Aneurysm ◽  
Vascular Complication ◽  
Allograft Loss ◽  
End Stage

Introduction: Renal Transplantation is the optimal treatment for end-stage renal disease.Among the surgical complication in Renal Transplant vascular complication is most dreadedand many lead to sudden allograft loss and increase patient morbidity and even mortality. Objective: To share our experience and analysis of outcome of vascular complicationsof Live related Renal Transplant in our Bangabandhu Sheikh Mujib Medical University(BSMMU), Dhaka. Materials & Methods: One hundred eighty two (182) live related Renal Transplantwere performed from July 2011 to March 2020. During this period we evaluated thiscases retrospectively to find out vascular complications and analyzed them for frequency,clinical presentation and their management and outcome. Result: The age of recipients range from 6-65 years, male 129, female 53 vascularcomplications are found in 8 cases — 1 Renal Artery Thrombosis, 2 venous thrombosis,1 Renal Artery aneurysm, 1 hematocele, 3 lymphocele. 4 patients needed graftnephrectomy, 2 lymphocele cases need lympho-peritoneal shunt and 1 improve bysclerotherapy with povidone-iodine, hematoma needs surgical evacuation. One patientdied after graft Nephrectomy due to sepsis. Conclusion: Major vascular complications are relatively uncommon after live relatedRenal Transplantation but still contributes a major factor of graft loss and patientmorbidity. According to these data we can conclude Renal Transplantation is safeprocedure for end stage renal disease. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.72-75

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 Improved survival with renal transplantation for end-stage renal disease due to granulomatosis with polyangiitis: data from the United States Renal Data System

2018 ◽  
Vol 77 (9) ◽  
pp. 1333-1338 ◽  
Author(s):  
Zachary S Wallace ◽  
Rachel Wallwork ◽  
Yuqing Zhang ◽  
Na Lu ◽  
Frank Cortazar ◽  
...  
Keyword(s):  
United States ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
End Stage Renal Disease ◽  
Granulomatosis With Polyangiitis ◽  
The United States ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage

BackgroundRenal transplantation is the optimal treatment for selected patients with end-stage renal disease (ESRD). However, the survival benefit of renal transplantation among patients with ESRD attributed to granulomatosis with polyangiitis (GPA) is unknown.MethodsWe identified patients from the United States Renal Data System with ESRD due to GPA (ESRD-GPA) between 1995 and 2014. We restricted our analysis to waitlisted subjects to evaluate the impact of transplantation on mortality. We followed patients until death or the end of follow-up. We compared the relative risk (RR) of all-cause and cause-specific mortality in patients who received a transplant versus non-transplanted patients using a pooled logistic regression model with transplantation as a time-varying exposure.ResultsDuring the study period, 1525 patients were waitlisted and 946 received a renal transplant. Receiving a renal transplant was associated with a 70% reduction in the risk of all-cause mortality in multivariable-adjusted analyses (RR=0.30, 95% CI 0.25 to 0.37), largely attributed to a 90% reduction in the risk of death due to cardiovascular disease (CVD) (RR=0.10, 95% 0.06–0.16).DiscussionRenal transplantation is associated with a significant decrease in all-cause mortality among patients with ESRD attributed to GPA, largely due to a decrease in the risk of death to CVD. Prompt referral for transplantation is critical to optimise outcomes for this patient population.

scholarly journals Understanding and using AlloSure donor derived cell-free DNA

2020 ◽  
Vol 12 (4) ◽  
pp. 917-924 ◽  
Author(s):  
R. K. Seeto ◽  
J. N. Fleming ◽  
S. Dholakia ◽  
B. L. Dale
Keyword(s):  
Renal Transplant ◽  
Graft Loss ◽  
Cost Effective ◽  
Low Grade ◽  
Cell Free Dna ◽  
Disease States ◽  
Transplant Patients ◽  
Free Dna ◽  
Obesity Hypertension ◽  
End Stage

Abstract Renal transplant is a lifesaving and cost-effective intervention for patients with End Stage Renal Failure. Yet it is often regarded as replacement therapy rather than a cure given the overall failure rate over time. With a shortage of organs, this global issue has been further compounded by increased incidences of obesity, hypertension and diabetes, such that the disease burden and need for transplantation continues to increase. Considering the lifetime of immunosupression in transplant patients, there will also be significant associated co-morbidities By leveraging the advances in innovation in Next Generation Sequencing, the field of transplant can now monitor patients with an optimized surveillance schedule, and change the care paradigm in the post-transplant landscape. Notably, low grade inflammation is an independent risk for mortality across different disease states. In transplantation, sub-clinical inflammation enhances acute and chronic rejection, as well as accelerates pathologies that leads to graft loss. Cell free DNA has been shown to be increased in inflammatory processes as we all as provide an independent predictor of all-cause mortality. This review considers the utility of AlloSure, a donor derived cell free DNA molecular surveillance tool, which has shown new clinical insights on how best to manage renal transplant patients, and how to improve patient outcomes.

scholarly journals Early Urological Complications After Live Related Renal Transplantation: An Update

2020 ◽  
Vol 46 (2) ◽  
pp. 68-72
Author(s):  
Tohid Mohammad Saiful Hossain ◽  
Tahmina Karim
Keyword(s):  
Kidney Transplant ◽  
Patient Survival ◽  
Surgical Complication ◽  
Graft Loss ◽  
Standard Of Care ◽  
Delay In Diagnosis ◽  
Post Transplant ◽  
Urological Complications ◽  
End Stage ◽  
High Degree

Background: Kidney transplant is the standard of care for end stage kidney disease and associated with immunological, vascular and urological complications. Urological complications remain the most common type of surgical complication in the early post-transplant period, inspite of major procedural advances many grafts are still being lost due to same. Objectives: The purpose of this review was to discuss the different presentations, compare various ureterovesical anastomosis techniques and provide a basic overview for the management of post-transplant urological complications hence to improve graft and patient survival. Methods: This study was a narrative review.  Recent available literature was searched by keywords. The most recent information from relevant articles were collected and reviewed. This write up was compiled after the review of articles from the last 50 years. Results: Majority of these complications could be traced back to the time of retrieval and anastomosis of ureter. So, the high degree of suspicion, early detection, accurate diagnosis and timely management of urological complications occurring after kidney transplant were the key tasks of transplant team managing the patients. A delay in diagnosis or management of these complications could lead to morbidity to the recipient even graft loss and or mortality. Conclusion: To minimize the early complications of post kidney transplantation high degree of suspicion and prompt intervention is needed for graft and patient survival. Bangladesh Med Res Counc Bull 2020; 46(2): 68-72

Risk Factors for Graft Loss Due to Acute Vascular Complications in Adult Renal Transplantation Using Grafts Without Vascular Anomalies

2019 ◽  
Vol 51 (9) ◽  
pp. 2939-2942 ◽  
Author(s):  
Gian Luigi Adani ◽  
Riccardo Pravisani ◽  
Umberto Baccarani ◽  
Matteo Faion ◽  
Sara Crestale ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplantation ◽  
Graft Loss ◽  
Vascular Complications ◽  
Vascular Anomalies

scholarly journals Practices and Results of Two Years Service from a single UK Renal Transplant Center

2010 ◽  
Vol 49 (177) ◽  
Author(s):  
P C Shrestha ◽  
J Dominguez-Escrig ◽  
B Gowardhan ◽  
D Rix ◽  
D Talbot
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Graft Function ◽  
Rejection Rate ◽  
Definitive Treatment ◽  
Team Approach ◽  
Developed Country ◽  
Set Up ◽  
One Year ◽  
End Stage

INTRODUCTION: End stage renal failure is a common condition requiring renal replacement therapy in the form of haemodialysis or peritoneal dialysis as a short-term measure with renal transplantation as a more definitive treatment option. The aim of this study was to evaluate the set up of arenal transplant unit in a developed country and compare its results with other centers of the world. METHODS: A retrospective observational study was conducted to see the results of two years activities of a well known renal transplant unit in the United Kingdom. A description of the setup of a renal transplant unit has been made and its results have been discussed. RESULTS: Of the total patients, who had transplants in the renal transplant unit in year 2006 and 2007, 209 were renal, 14 were simultaneous kidneypancreas and two were pancreas after kidney transplants. Our one year graft survival rate was 93%, delayed graft function was 15%, early rejection rate was 11% and mortality rate was 3% in one year follow up. CONCLUSIONS: To attain good results in renal transplantation surgery, a multi-disciplinary team approach is crucial. Our set up is an example where the results are comparable to published and unpublished data from other established units world-wide. Keywords: complications, immunosuppression, renal transplant.

scholarly journals Anesthesia management of renal transplantation: A retrospective analysis

2021 ◽  
Vol 8 (2) ◽  
pp. 172-178
Author(s):  
Pradeep Tiwari ◽  
Aarti Kulkarni ◽  
Shraddha Mathkar
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Disease ◽  
Retrospective Analysis ◽  
End Stage Renal Disease ◽  
Anesthesia Management ◽  
Co Morbidity ◽  
Stage Renal Disease ◽  
End Stage ◽  
Preoperative Patient

Transplantation provides a near normal life and excellent rehabilitation compared to dialysis and is preferred method of treatment for end stage renal disease patients. After ethics committee approval, a retrospective analysis of recipients of renal transplantation was done at our hospital from January 2010 to December 2014. Preoperative patient status, fluid management, hemodynamic parameters, anesthesia management, and perioperative complications were recorded and analyzed.Total 100 patients were recorded, 92% living and 8% were cadaveric related transplant. 92% were done electively. Most common co-morbidity recorded was hypertension in 49% patients. Predominant cause of end stage renal disease was chronic glomerulonephritis (41%). General anesthesia was technique of choice in all patients, 27 also received epidural. Invasive blood pressure monitoring was done in 3 patients with cardiac co-morbidities. 15% patients required blood transfusion. CVP maintained > 12 mmHg and maximum at de-clamping. Mean arterial pressure maintained above 95 mmHg. Ionotropic support required in 2 patients. 76% patients were transfused with only crystalloid (NS and/or RL) while 24 patients received a combination of both crystalloid and colloid. 97% patients were extubated postoperatively while 3% required ventilator support. Recovery time with desflurane was significantly less as compared to other inhalational agents. One patient died postoperatively. Recent advances in surgical techniques, anesthesia management and immunosuppressive drugs have made renal transplantation safe and predictable. Preoperative patient optimization, intraoperative physiological stability and postoperative care of renal transplant patients have contributed to the success of renal transplant program in our hospital.

scholarly journals Electroconvulsive Therapy in a Renal Transplantation Patient: A Rare Combination of Disease and Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Giovanni Malaty ◽  
Kerilyn Godbe ◽  
Mehdi Elmouchtari ◽  
Gurjot Malhi ◽  
Justin White ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Disease ◽  
Electroconvulsive Therapy ◽  
End Stage Renal Disease ◽  
Psychotic Symptoms ◽  
Safety And Efficacy ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

The safety and efficacy of electroconvulsive therapy (ECT) for the treatment of psychiatric disorders have been demonstrated in a wide variety of patients, including postoperative patients and those who are pregnant. While several reports highlight the safety of this treatment in heart and liver transplantation patients, there is a relative lack of literature detailing the safety profile of ECT in an individual with recent kidney transplantation. Here, we explore the case of a patient with a recent renal transplant secondary to diabetes-related end-stage renal disease (ESRD) who underwent a successful course of ECT treatment. A 57-year-old Caucasian male with a past psychiatric history of schizoaffective disorder, bipolar type, and a past medical history of end-stage renal disease with recent right renal transplantation was admitted to the inpatient psychiatry unit. The admission was via a temporary detention order (TDO) for suicidality and auditory hallucinations promoting self-harm. The patient’s depressive and delusional history was well-documented and had been refractory to several courses of psychotherapeutic and pharmacologic management. Electroconvulsive therapy was subsequently initiated and was well-tolerated. Treatments progressively alleviated his depressive and psychotic symptoms and did not adversely affect the function of his transplanted kidney, which was closely monitored throughout the treatment process. This case demonstrated the safety and efficacy of ECT treatment in an individual with recent renal transplant and may prompt further trials into establishing safety and efficacy in larger study populations.

Simultaneous endovascular revascularization of external iliac artery dissection and transplant renal artery stenosis in a recent renal allograft recipient

2021 ◽  
Vol 20 ◽  
Author(s):  
Rajesh Vijayvergiya ◽  
Atit Gawalkar ◽  
Ganesh Kasinadhuni ◽  
Ashish Sharma ◽  
Sarbpreet Singh ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Iliac Artery ◽  
Vascular Complications ◽  
External Iliac Artery ◽  
Artery Stenosis ◽  
Artery Dissection ◽  
Renal Allograft Recipient ◽  
Transplant Renal Artery Stenosis

Abstract Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion.

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