Prostate Cancer in Renal Transplant Recipients: Results from a Large Contemporary Cohort

Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60–73) and 45.9 mL/min (IQR 31.5–63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48–191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02–10). The biopsy Gleason score was ≥8 in 12.8%; 11.6% and 6.1% patients had suspicion of ≥cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31–106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16–0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided

Radical Prostatectomy for Nonmetastatic Prostate Cancer in Renal Transplant Recipients: Outcomes for a Large Contemporary Cohort and a Matched Comparison to Patients Without a Transplant

BACKGROUND AND OBJECTIVE: It is unknown whether renal transplant receipt (RTR) status can affect perioperative and oncological outcomes of radical prostatectomy (RP). Our aim was to evaluate oncological and functional outcomes of RTR patients treated with RP for cN0M0 prostate cancer (PCa) via comparison with a no-RTR cohort. METHODS: RTR patients who had undergone RP at seven European institutions during 2001-2022 were identified. A multi-institutional cohort of no-RTR patients treated with RP during 2004-2022 served as the comparator group. Propensity score matching (PSM) at a ratio of 1:4 was used to match no-RTR patients to the RTR cohort according to age, prostate-specific antigen, and final pathology features. We used Kaplan-Meier plots and multivariable Cox, logistic, and Poisson log-linear regression models to test the outcomes of interest. KEY FINDINGS AND LIMITATIONS: After PSM, we analyzed data for 102 RTR and 408 no-RTR patients. RTR patients experienced higher estimated blood loss (EBL), longer length of hospital stay (LOS) and time to catheter removal, higher postoperative complication rates, and a lower continence recovery rate (all p < 0.001). On multivariable analyses, RTR independently predicted unfavorable operative time (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.18-1.25), LOS (OR 1.57, 95% CI 1.32-1.86), EBL (OR 2.24, 95% CI 2.18-2.30), and time to catheter removal (OR 1.93, 95% CI 1.68-2.21), but not complications or continence recovery. There were no significant differences for any oncological outcomes (biochemical recurrence, local or systemic progression) between the RTR and no-RTR groups. While no PCa deaths were recorded, the overall mortality rate was significantly higher in the RTR group (17% vs 0.5%, p < 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS: Although RP is feasible for RTR patients, the procedure poses non-negligible surgical challenges, with longer operative time and LOS and higher EBL, but no major differences in terms of complications and continence recovery. The RTR group had similar oncological outcomes to the no-RTR group but significantly higher overall mortality related to causes other than PCa. Therefore, careful selection for RP is required among candidates with previous RTR. PATIENT SUMMARY: Removal of the prostate for prostate cancer is possible in patients who have had a kidney transplant, and cancer control outcomes are comparable to those for the general population. However, transplant patients have a higher risk of death from causes other than prostate cancer and the prostate surgery is likely to be more challenging

European Society for Organ Transplantation (ESOT) Consensus Statement on the Role of Pancreas Machine Perfusion to Increase the Donor Pool for Beta Cell Replacement Therapy

The advent of Machine Perfusion (MP) as a superior form of preservation and assessment for cold storage of both high-risk kidney’s and the liver presents opportunities in the field of beta-cell replacement. It is yet unknown whether such techniques, when applied to the pancreas, can increase the pool of suitable donor organs as well as ameliorating the effects of ischemia incurred during the retrieval process. Recent experimental models of pancreatic MP appear promising. Applications of MP to the pancreas, needs refinement regarding perfusion protocols and organ viability assessment criteria. To address the “Role of pancreas machine perfusion to increase the donor pool for beta cell replacement,” the European Society for Organ Transplantation (ESOT) assembled a dedicated working group comprising of experts to review literature pertaining to the role of MP as a method of improving donor pancreas quality as well as quantity available for transplant, and to develop guidelines founded on evidence-based reviews in experimental and clinical settings. These were subsequently refined during the Consensus Conference when this took place in Prague.</p

First World Consensus Conference on pancreas transplantation: Part II - recommendations.

Funder: Fondazione Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/100007368Funder: Tuscany Region, Italy; Id: http://dx.doi.org/10.13039/501100009888Funder: Pisa University Hospital, Pisa, ItalyFunder: University of Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/501100007514The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246

Study of innovative techniques for preserving the pancreas in preclinical transplantation models

La transplantation pancreatique est le traitement de choix du diabete de type instable. Les deux principales causes d’echec precoces de cette transplantation sont la pancreatite et la thrombose veineuse du greffon. Le pancreas est un organe particulierement sensible aux lesions d’ischemie reperfusion du fait de son anatomie et de sa physiologie. La technique actuelle de reference de preservation des transplants apres le prelevement et avant la transplantation demeure la conservation statique hypothermique. Les modifications des caracteristiques des donneurs amenent les equipes de transplantation a considerer des pancreas de plus en plus fragiles et donc sensibles aux lesions d’ischemie reperfusion. L’objectif de ce travail a ete d’etablir les modalites d’une technique innovante de preservation des transplants pancreatiques sur machine de perfusion hypothermique pulsatile. La premiere etape a ete d’evaluer la faisabilite technique et l’innocuite de cette perfusion sur des pancreas humains recuses pour la transplantation. La seconde etape a ete de tester ce modele de perfusion sur des pancreas de primate non humain. La troisieme etape a consiste en une evaluation de l’impact de la preservation pulsatile hypothermqiue dans un modele d’allo transplantation de pancreas chez le porc diabetique. La quatrieme etape a ete realisee en collaboration avec l’universite d’Oxford de mettre en place un modele de perfusion normothermique ex situ de pancreas. Les prochaines etapes seront d’evaluer l’interet de la preservation hypothermique pulsatile de pancreas par une solution enrichie en PEG et oxygenee dans un modele porcin de type donneur decede apres arret circulatoire. Apres avoir mis au moins les modalites de perfusions hypothermique pulsatile du pancreas et montre son efficacite notament sur la preservation du pancreas exocrine, nous travaillons actuelement a la mise en place d’un essai clinique evalutant cette perfusion pulsatile hypothermique.Pancreatic transplantation is the treatment of choice for unstable diabetes. The two main causes of early failure in this transplant are pancreatitis and venous graft thrombosis. Due to its anatomy and physiology the pancreas is an organ that is particularly sensitive to ischemia reperfusion injury. The current standard technique for preserving transplants after removal and before transplantation remains static hypothermic preservation. Changes in donor characteristics have led transplant teams to consider increasingly fragile pancreases, which are even more susceptible to ischemia reperfusion injury. The objective of this work was to establish the modalities of an innovative technique for the preservation of pancreatic transplants on a pulsatile hypothermic perfusion machine.The first step was to assess the technical feasibility and safety of this perfusion on human pancreas that had been discarded for transplantation. The second step was to test this perfusion model on nonU human primate pancreas. The third step consisted of an evaluation of the impact of hypothermic pulsatile preservation in a model of pancreatic alloUtransplantation in diabetic pigs. The fourth step was carried out in collaboration with the University of Oxford in order to develop normothermic ex situ reperfusion of the pancreas. The next step will be to assess the value of pulsatile hypothermic preservation of the pancreas with a PEG solution and oxygenation in a porcine donation model of death after circulatory arrest. We have in this study determined the parameters for hypothermic pulsatile perfusion of the pancreas and shown its effectiveness in the preserving of the exocrine pancreas. We are now working on the implementation of a clinical trial evaluating this hypothermic pulsatile perfusion

Les tumeurs urothéliales de vessie de stade pT1 de haut grade (résultats oncologiques en fonction de la prise en charge)

Toute la difficulté de la prise en charge des tumeurs urothéliales de vessie de stade pT1 de haut grade est dans la sélection des malades pour qui le traitement conservateur par BCG thérapie sera un échec et qui doivent alors avoir une cystectomie précocement. Cette série rétrospective sur 108 patients a comparé les résultats oncologiques en fonction de la prise en charge, il n'y a pas existé de différence significative de survie. Les facteurs de mauvais pronostics dégagés dans cette étude sont : une taille tumorale de plus de trois centimètres, une tumeur multifocale, l absence de musculeuse sur la première résection, l'envahissement du chorion profond ( stade pT1b), et la présence d'emboles vasculaires tumoraux. Cependant aucun d'eux ne permet isolément d'indiquer une cystectomie précoce. Le choix dans la prise en charge thérapeutique doit se faire sans délai et résulte d'une analyse de l'ensemble de ces facteurs de risques.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Arterial ligation in the context of living donor nephrectomy: Which device to employ? Experience feedback on an automatic vascular clamp

International audienceThe choice of arterial ligation modality in the context of nephrectomies for living kidney donation poses a significant challenge. Due to the contraindication of Hem-O-Lock™ clips for this indication and the discontinuation of certain commercially available ligature devices suitable for this purpose, this issue remains particularly relevant. We report a serious adverse event with an arterial ligation device (Signia™ Stapling System, Medtronic, Dublin, Ireland). We observed intraoperative dislodgement of clips from the stump of the renal artery, resulting in significant bleeding and necessitating an emergency conversion to a subcostal approach. The experiential insights from each transplantation team regarding ligation modalities and the rigorous evaluation of medical devices are crucial imperative to ensure the donor's safety

Exploring the correlation between arterial clamping duration during kidney surgeries and kidney partial oxygen pressure levels

International audienceNo abstract availabl