The outcome of kidney transplants with multiple renal arteries

BACKGROUND: The use of grafts with multiple renal arteries has been considered a relative contraindication because of the increased incidence of vascular and urologic complications The aim of this study is to determine whether the kidney grafts with multiple arteries have any adverse effect upon post-transplant graft and patient survival. METHODS: We reviewed the records of 225 adult kidney transplants done consecutively at our institution. Twenty-nine patients (12.8%) had grafts with multiple renal arteries. We analyzed the incidence of post-transplant hypertension and vascular complications, mean creatinine levels, patient and graft survival. In 17 cases reconstruction was done as conjoined anastomosis between two arteries of equal size, and in 6 cases as end-to-side anastomosis of smaller arteries to larger arteries. Multiple anastomoses were performed in 6 cases. RESULTS: In one patient postoperative bleeding occurred. Mean systolic blood pressures, creatinine levels at first year and last follow-up and complication rates were all in acceptable ranges. There was no significant difference in graft and patient survival between multiple and single renal artery allografts. CONCLUSION: Although the kidney grafts with multiple renal arteries have been considered a relative contraindication because of the increased risk of complications, in our study allografts with multiple arteries were used successfully in kidney transplantation

The Management of Acute Cholecystitis in Chronic Hemodialysis Patients: Percutaneous Cholecystostomy Versus Cholecystectomy

Treatment of acute cholecystitis in chronic hemodialysis (HD) patients still remains controversial. Because of underlying disease that can influence surgical results, less invasive alternative managements have been tried over the last decades. The goal of this study was to analyze the results of cholecystectomy versus percutaneous cholecystostomy for acute cholecystitis (AC) in chronic HD patients.Treatment of acute cholecystitis in chronic hemodialysis (HD) patients still remains controversial. Because of underlying disease that can influence surgical results, less invasive alternative managements have been tried over the last decades. The goal of this study was to analyze the results of cholecystectomy versus percutaneous cholecystostomy for acute cholecystitis (AC) in chronic HD patients.METHODS:All patients with end-stage renal disease who were treated for AC were identified retrospectively from our medical records. Between July 2007 and September 2011, 47 patients were treated for AC while they were on chronic HD. The records of these patients were reviewed for documented AC and its treatment.RESULTS:Of the 47 HD patients, 26 (55.3&nbsp;%) underwent cholecystectomy (CC), while 21 (44. 7&nbsp;%) had a percutaneous cholecystostomy (PC) for AC as an initial treatment. The mean length of follow-up was 20.4&thinsp;&plusmn;&thinsp;16&nbsp;months in PC and 18&thinsp;&plusmn;&thinsp;15&nbsp;months in CC patients. The success rate was higher in CC patients compared to PC patients (92. 3 versus 66.7&nbsp;%, p&thinsp;=&thinsp;0.0698). Eleven (52. 4&nbsp;%) patients who had PC subsequently underwent CC; six open CC and five delayed laparoscopic CC were performed. Of the 26 patients who underwent CC, 18 were performed emergently due to the persistence of AC-related symptoms and gangrenous and perforated gallbladders. Eight were initially treated conservatively and then underwent elective cholecystectomy at an interval of 32&thinsp;&plusmn;&thinsp;24 (range&thinsp;=&thinsp;14-59) days following initial treatment. In emergent CC, 10 (55.6&nbsp;%) were completed laparoscopically, three were open, and five (33.3&nbsp;%) had conversions. In elective CC patients, two were conversions, but the remainder (75&nbsp;%) had laparoscopic CC. Readmission rates were higher in the PC group (33.3 versus 12.5&nbsp;%, p&thinsp;=&thinsp;0.1732). Although AC-related mortality was higher in PC patients, there was no statistically significant difference in the patient survival rate between the two groups (Kaplan-Meier analysis, Fig. 1, 19 versus 7.7&nbsp;%; p&thinsp;=&thinsp;0.4035), and the overall mortality rate was higher in the PC group (33.7 versus 15.7&nbsp;%, p&thinsp;=&thinsp;0.2737).CONCLUSION:This study confirms that the safety and effectiveness of CC has a higher success rate and lower morbidity and mortality rate compared with percutaneous cholecystostomy for acute cholecystitis in chronic HD patients.</p

Ratio of remnant to total liver volume or remnant to body weight: which one is more predictive on donor outcomes?

AbstractBackroundRight lobe donations are known to expose the donors to more surgical risks than left lobe donations. In the present study, the effects of remnant volume on donor outcomes after right lobe living donor hepatectomies were investigated.MethodsThe data on 262 consecutive living liver donors who had undergone a right hepatectomy from January 2004 to June 2011 were retrospectively analysed. The influence of the remnant on the outcomes was investigated according to the two different definitions. These were: (i) the ratio of the remnant liver volume to total liver volume (RLV/TLV) and (ii) the remnant liver volume to donor body weight ratio (RLV/BWR). For RLV/TLV, the effects of having a percentage of 30% or below and for RLV/BWR, the effects of values lower than 0.6 on the results were investigated.ResultsComplication and major complication rates were 44.7% and 13.2% for donors with RLV/TLV of ≤30%, and 35.9% and 9.4% for donors with RLV/BWR of < 0.6, respectively. In donors with RLV/TLV of ≤30%, RLV/BWR being below or above 0.6 did not influence the results in terms of liver function tests, complications and hospital stay. The main impact on the outcome was posed by RLV/TLV of ≤30%.ConclusionRemnant volume in a right lobe living donor hepatectomy has adverse effects on donor outcomes when RLV/TLV is ≤30% independent from the rate of RLV/BWR with a cut-off point of 0.6

Living donor liver transplantation for obese patients: Challenges and outcomes

Living donor liver transplantation (LDLT) is an accepted option for end-stage liver disease, particularly in countries in which there are organ shortages. However, little is known about LDLT for obese patients. We sought to determine the effects of obesity on pretransplant living donor selection for obese recipients and their outcomes. On the basis of body mass index (BMI) values, 148 patients were classified as normal weight (N), 148 were classified as overweight (OW), and 74 were classified as obese (O). O recipients had significantly greater BMI values (32.1 +/- 1.6 versus 23.2 +/- 1.9 kg/m(2), P Living donor liver transplantation (LDLT) is an accepted option for end-stage liver disease, particularly in countries in which there are organ shortages. However, little is known about LDLT for obese patients. We sought to determine the effects of obesity on pretransplant living donor selection for obese recipients and their outcomes. On the basis of body mass index (BMI) values, 148 patients were classified as normal weight (N), 148 were classified as overweight (OW), and 74 were classified as obese (O). O recipients had significantly greater BMI values (32.1&thinsp;&plusmn;&thinsp;1.6 versus 23.2&thinsp;&plusmn;&thinsp;1.9 kg/m2, P&thinsp;&lt;&thinsp;0.001) and received larger actual grafts (918.9&thinsp;&plusmn;&thinsp;173 versus 839.4&thinsp;&plusmn;&thinsp;162 g, P&thinsp;=&thinsp;0.002) than recipients with normal BMI values. Donors who donated to O recipients had a greater mean BMI (26.3&thinsp;&plusmn;&thinsp;3.8 kg/m2) than those who donated to N recipients (24.4&thinsp;&plusmn;&thinsp;3.2 kg/m2, P&thinsp; =&thinsp;0.001). Although O recipients were more likely to face some challenges in finding a suitable living donor, there were no differences in graft survival [hazard ratio (HR)&thinsp;=&thinsp;0.955, 95% confidence interval (CI)&thinsp;=&thinsp;0.474-1.924, P&thinsp;=&thinsp;0.90] or recipient survival (HR&thinsp;=&thinsp;0.90, 95% CI&thinsp;=&thinsp;0.56-1.5, P&thinsp; =&thinsp;0.67) between the 3 groups according to an adjusted Cox proportional hazards model. There were no significant differences in posttransplant complication rates between the 3 recipient groups or in the morbidity rates for the donors who donated to O recipients versus the donors who donated to OW and N recipients (P&thinsp;=&thinsp;0.26). Therefore, we recommend that obese patients undergo pretransplant evaluations. If they are adequately evaluated and selected, they should be considered for LDLT. Liver Transpl 20:311-322, 2014. &copy; 2013 AASLD.</p