scholarly journals Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1248
Author(s):  
Saulė Bikauskaitė ◽  
Kamilė Počepavičiūtė ◽  
Linas Velička ◽  
Antanas Jankauskas ◽  
Darius Trumbeckas ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Artery ◽  
Graft Function ◽  
Vascular Complications ◽  
Vascular Reconstruction ◽  
Main Task ◽  
Ovarian Vein ◽  
Accessory Renal Artery ◽  
Ischemic Time ◽  
Main Renal Artery

Background: In the case of complicated kidney transplantation, when the accessory artery is severed, the main task is to decide whether to restore renal blood flow and which method should be used. In this report, we present a case of kidney transplantation with vascular reconstruction using an ovarian vein as an interposition graft between a larger branch of the main renal artery and the lower polar artery which was severed during kidney explantation. Case summary: Kidney transplantation using an ovarian vein was performed for a 34-year-old woman with end-stage renal disease on 1 April 2020 in the Hospital of Lithuanian university of health sciences (LUHS) Kaunas Clinics. A lower accessory renal artery was severed during kidney explantation. As the ovarian vein of the donor remained and matched the diameter of the severed vessel, it was decided to use it as an insertion between the main renal artery and the accessory renal artery of the inferior pole. The cold ischemic time was 770 min and the warm ischemic time was 37 min. A month after transplantation, the patient’s condition and daily urine output were normal and the serum creatinine level decreased rapidly. Fifteen months after the surgery, the function and structure of the transplant remained normal and there was no evidence of serious vascular complications on CT scans. This is the first case where graft function was verified after transplantation using three-dimensional CT angiography. Conclusions: If an inferior polar artery is severed, vascular reconstruction must be performed to preserve the function of the graft. Usually, the gonadal vein is available during donor nephrectomy; therefore, it can be explanted without additional difficulties or incisions. Although we have not reported any complications, further studies are recommended on the long-term outcomes of this alternative approach for the reconstruction of short renal arteries.

scholarly journals Kidney transplant outcomes after medical assistance in dying

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Patrick P. Luke ◽  
Anton Skaro ◽  
Alp Sener ◽  
Ephraim Tang ◽  
Max Levine ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Large Scale ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Medical Assistance ◽  
Ischemic Time ◽  
Transplant Outcomes ◽  
Medical Assistance In Dying ◽  
Cold Ischemic Time ◽  
The Mean

Introduction: After nearly four years of Canadian experience with medical assistance in dying (MAiD), the clinical volume of organ transplantation following MAiD remains low. This is the first Canadian report evaluating recipient outcomes from kidney transplantation following MAiD. Methods: This was a retrospective review of the first nine cases of kidney transplants following MAiD at a Canadian transplant center. Results: Nine patients underwent MAiD followed by kidney retrieval during the study period. Their diagnoses were largely neuromuscular diseases. The mean warm ischemic time was 20 minutes (standard deviation [SD] 7). The nine recipients had a mean age of 60 (SD 19.7). The mean cold ischemic time was 525 minutes (SD 126). Delayed graft function occurred in only one patient out of nine. The mean 30-day creatinine was 124 umol/L (SD 52) . The mean three-month creatinine was 115 umol/L (SD 29). Conclusions: We report nine cases of kidney transplantation following MAiD. The process minimized warm ischemia, resulting in low delayed graft function rates, and acceptable post-transplant outcomes. Further large-scale research is necessary to optimize processes and outcomes in this novel clinical pathway.

scholarly journals Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rao Chen ◽  
Haifeng Wang ◽  
Lei Song ◽  
Jianfei Hou ◽  
Jiawei Peng ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Graft Function ◽  
Deceased Donor ◽  
Donor Kidney ◽  
Ischemic Time ◽  
Deceased Donor Kidney ◽  
One Year ◽  
Donor Kidney Transplantation ◽  
Deceased Donor Kidney Transplantation

Abstract Background Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival. Methods This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors. Results The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort. The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59 and 99.74%, respectively, for the groups with and without DGF (P < 0.05). Conclusion The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

MO975INFLUENCE OF THE TYPE OF DIALYSIS ON SHORT-TERM KIDNEY TRANSPLANT RESULTS. EXPERIENCE OF OUR  CENTER

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Maria Lanau Martinez ◽  
Marta Artamendi Larrañaga ◽  
Celia Garijo Pacheco ◽  
Iñigo Gaston Najarro ◽  
Guillermo Pereda Bengoa ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Acute Rejection ◽  
Graft Function ◽  
Vascular Complications ◽  
Group Versus ◽  
Infectious Complications ◽  
Delayed Graft Function ◽  
Dialysis Technique

Abstract Background and Aims Kidney transplantation (KT) is considered to be the best option for renal replacement therapy (RRT) in patients with advanced chronic kidney disease, surpassing any dialysis technique in quality and life expectancy. However, results in terms of how pre-KT dialysis technique influences graft and recipient survival are mixed. Some studies show a higher incidence of vascular complications in the immediate post-transplant period and higher rates of acute rejection in patients coming from peritoneal dialysis (PD) versus those coming from hemodialysis (HD) while others observe a lower incidence of delayed graft function in the PD group of patients versus those on HD. Our objective is to analyze if there are differences in immediate post-kidney transplantation and at 6 months of follow-up depending on the pre-KT dialysis technique, PD versus HD. Method Observational study of all patients with KT of cadaveric donor from the beginning of the KT program in our Center, from August 2011 to August 2019. We analyzed the characteristics of donors and recipients according to the technique (PD/HD), the evolution and complications in the immediate post-KT, as well as results at 6 months of follow-up in terms of complications, renal function and survival of the recipient and the graft. For statistical analysis we used SPSS 25. We compared qualitative variables by means of Xi2 test, and quantitative variables by t of Student, or U of Mann-Whitney if the variables did not follow a normal distribution. A value of p &lt;0.05 was considered significant. Results 121 patients were included, 71 of whom were in the HD group, versus 50 who were in the PD group. The recipients in the HD group were significantly older (57.2 vs 51.6 years, p 0,02) and stayed on dialysis longer (33.8 vs 26.8 months). We observed no difference in the recipient's cardiovascular history, except for increased smoking in the HD group (52.1% vs. 24%). The donor-recipient immune profile was similar in both groups. As for the incidence of delayed graft function, it was significantly lower in the PD group (14.9% vs 34.3%), finding no difference in renal function at hospital discharge or in days of admission. In the first 6 months of follow-up, we found no differences in terms of vascular, urological or infectious complications. There were also no differences in the incidence of acute rejection, renal function measured by creatinine (HD 1.47 vs DP 1.50 mg/dl) and proteinuria (HD 200 vs DP 216 mg/24 hours). Graft and recipient survival at 6 months of TR follow-up were similar in both groups. Conclusion In our experience, we have not found differences in the evolution at 6 months of the KT according to the modality of dialysis , nor greater incidence of vascular, immunological or other complications, with a survival of graft and receptor superimposable between both groups, PD or HD.

Impairment of long-term graft function after kidney transplantation by intraoperative vascular complications

2008 ◽  
Vol 40 (4) ◽  
pp. 869-873 ◽  
Author(s):  
Guido Fechner ◽  
Carolin von Pezold ◽  
Stefan Hauser ◽  
Thomas Gerhardt ◽  
Hans-Ulrich Klehr ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Vascular Complications

scholarly journals Assessment of risk factors for hospital readmission after kidney transplantation

2021 ◽  
Author(s):  
Mahmoud Tavakkoli ◽  
Amir Yarahmadi ◽  
Mahin Ghorban Sabbagh ◽  
Mona Najaf Najafi ◽  
Milad Tavakoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplantation ◽  
Hospital Readmission ◽  
Intraoperative Complications ◽  
Demographic Data ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Post Discharge ◽  
Ischemic Time ◽  
Cold Ischemic Time

Background and Purpose: Hospital readmission after kidney transplantation is a real challenge for both patients and healthcare systems. Assessment of the risk factors of readmission after kidney transplantation is vital and can reduce morbidity and cost in transplant recipients and donors. The aim of the current study was to determine the risk factors of hospital readmission in patients undergoing kidney transplantation in Montaserieh Hospital of Mashhad, northeast of Iran. Materials and Methods: This retrospective study included 523 first kidney transplant patients between January 2013 and March 2019 from the Montaserieh Hospital Information System (HIS) of Mashhad, Iran. Every-time readmission was the study primary outcome. Donors and recipient's demographic data, recipient's comorbidities, reasons for end-stage renal disease (ESRD), panel reactive antibody (PRA) status, dialysis parameters, cold ischemic time, and delayed graft function (DGF) were the potential risk factors. Statistical analysis was done using Chi-square and Student's t-test. Results: Data from 523 patients were assessed for potential eligibility. Based on the exclusion criteria, data from 479 patients were included in the final analysis. 174 (36.3%) patients were never readmitted, and 305 (63.7%) were readmitted at least once post-discharge. 39 (12.8%) were readmitted within the first-month post-discharge. Older age, sex, higher prevalence of comorbidities, diabetes and hypertension, duration of primary disease before transplantation, hemodialysis and duration of pre-transplant dialysis, mean pre-transplant platelet count, intraoperative complications, increased cold ischemic time, and delayed graft function were associated with a higher prevalence of readmission (p<0.05). Conclusion Our results showed that different independent variables and patients' comorbidities were important risk factors for readmission after kidney transplantation. Early prediction of these risk factors could result in prevention from readmission in patients undergoing kidney transplantation.

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