Outcomes of Kidney Transplantations From the Same Deceased Donor to Two Different Recipients: A Single-Center Experience.

BACKGROUND: Kidney transplantation is the best treatment method for end-stage renal disease. Technically, left kidney transplantation is easier than right kidney, and the complication rates in the right are higher than the left kidney. We performed 28 kidney transplantations from 14 deceased donors between November 2010 and May 2016. Our aim was to share our outcomes and experiences about these 28 patients. METHODS: We performed 182 kidney transplantations between November 2010 and May 2016. Fifty-four kidney transplantations were performed from deceased donors. Thirty-two of these were performed from 16 of the same donors. These 32 recipients' data were collected and retrospectively analyzed. We excluded the transplantations from two same-donors to their four recipients in this study. The remaining 28 recipients were included in the study. RESULTS: The left and right kidney recipients' numbers were equal (14:14). The left kidney:right kidney rate was 11:3 in the first kidney transplantation recipient group; in the second kidney transplantation recipient group, the rate was 3:11. The difference was statistically significant (P = .002). We found no statistical differences for sex, mean age, and body mass index of recipients, total ischemic time of grafts, hospitalization times, creatinine levels at discharge time, and current ratio of postoperative complications of recipients (P > .05). CONCLUSIONS: There were no differences in the left or the right kidneys or in the first and the second kidney transplantations during the long follow-up period.

Should Interventional Radiology or Open Surgery Be the First Choice for the Management of Ureteric Stenosis After Transplantation? Dual-Center Study.

BACKGROUND: Ureteric stenosis (US) is the most common urologic complication after kidney transplantation. In this dual-center retrospective study we compared the efficacy and safety of open surgery versus interventional radiology for the management of US. METHODS: From 2009 to January 2016, US was treated by surgical revision in 22 (7.8%) out of 281 recipients at one center (group 1) and managed by percutaneous nephrostomy with antegrade nephroureteral stenting (PNAS) in 22 (14.2%) out of 155 recipients at the other center (group 2). RESULTS: Three patients in group 1 required reintervention and again were treated with open surgery. With a mean follow-up of 42.1 ± 38.7 months, graft function improved in all but one patients (95%). Three patients in group 2 were admitted with relapse of US not amenable to 2nd PNAS, and 2 of them were managed with surgery. These 3 and 2 other cases with improved graft function after PNAS lost their grafts and returned to hemodialysis. The remaining 17 patients (77%) still have functioning grafts. There was no statistically significant difference between the efficacy of PNAS and open surgery for the management of post-transplantation US. However; a benefit in favor of open surgery existed for type 2 urinary tract obstruction in terms of decreased reintervention rate and much better protection of the graft function and survival. CONCLUSIONS: Both interventional radiology and open surgery have acceptable efficacy rates in the management of ureteric complications after renal transplantation. Open surgery is a better treatment option for type 2 obstruction.

A Rare Cause of Diarrhea in a Kidney Transplant Recipient: Dipylidium caninum.

We report the first case of dipylidiasis in a kidney transplant recipient. Watery diarrhea due to Dipylidium caninum was observed in a male patient who had been undergone kidney transplantation 2 years before. The patient was successfully treated with niclosamide. D. caninum should be considered as an agent of diarrhea in transplant patients.

Preemptive Kidney Transplantation: The Initial Experience of a Single Center.

BACKGROUND: Kidney transplantation is the best treatment method for end-stage renal disease. Outcomes of the preemptive kidney transplantation are better than non-preemptive kidney transplantation. Preemptive kidney transplantation is performed as a small percentage of kidney transplantations worldwide. We performed 15 preemptive kidney transplantations from living donors between November 2010 and April 2014. We present our experiences and outcomes for these 15 preemptive kidney transplantations. METHODS: We performed 110 kidney transplantations between November 2010 and April 2014. Fifteen of the kidney transplantations were performed from living related donors to preemptive recipients. These 15 preemptive recipients and their donors' data were collected and retrospectively analyzed. RESULTS: The mean age of recipients and donors was 37.2 years (range, 4-60) and 50.6 years (range, 28-64), respectively. The male-female ratios were 10:5 in the recipients and 8:7 in the donors. Nine left kidneys and 6 right kidneys were recovered. Nine kidneys had a single artery; the other 6 kidneys had 2 renal arteries. The mean warm ischemic time was 219.5 seconds (range, 90-480). The mean hospitalization times were 5.9 days (range, 4-10) and 4.9 days (range, 3-9) for the recipients and the donors, respectively. The mean follow-up time was 20.3 months (range, 0.5-37) for recipients. Graft survival was 100% in this period. BK virus nephropathy occurred in only 1 pediatric recipient. One patient had a recurrent disease that was the cause of the renal failure. They graft functions were stable. No kidney was lost from rejection, technical causes, infection, or recurrent disease. The donors live their lives with no problems. CONCLUSIONS: Preemptive kidney transplantation is a better therapeutic option than is non-preemptive kidney transplantation for patients with chronic renal failure. Kidney transplantation should be performed if possible before beginning dialysis for these patients.

HLA-A, -B, -DRB1 allele and haplotype frequencies and comparison with blood group antigens in dialysis patients in the East Anatolia region of Turkey.

AIM: The first aim of that study was to investigate HLA class I and class II allele and haplotype frequencies in renal dialysis patients who live in East Anatolia in Turkey. Our second aim was to investigate whether there was a relationship between ABO and D blood group antigens and HLA alleles and haplotypes for the study group. MATERIALS AND METHODS: HLA class I and II polymorphisms in 408 renal dialysis patients were studied using sequence-specific primers (SSP) and sequence-specific oligonucleotides (SSO). Blood group antigens were detected by agglutination methods on microplates. RESULTS: A total of 16 HLA-A, 34 HLA-B, and 15 HLA-DRB1 alleles were identified. The most frequent HLA-A alleles were HLA-A*02, HLA-A*24, and HLA-A*11. The most frequent HLA-B alleles were HLA-B*35, HLA-B*51, and HLA-B*44. In case of HLA-DRB1; HLA-DRB1*11, HLA-DRB1*04, and HLA-DRB1*13 were first 3 alleles with higher frequency, in order. In the combination of those 3 alleles, the most frequent HLA-A-B-DRB1 haplotypes were HLA-A*02-B*51-DRB1*11, HLA-A*11-B*35-DRB1*11, A*24-B*35-DRB1*11. The frequency of ABO, D blood group antigens were observed as 0.168 for A Rh(+), 0.019 for A Rh(-), 0.057 for B Rh(+), 0.013 for B Rh(-), 0.123 for O Rh(+), 0.014 for O Rh(-), 0.018 for AB Rh(+), and 0.001 for AB Rh(-). While A Rh(+) samples with HLA-A*02 and HLA-DRB1*11 had the highest frequencies (0.067 and 0.088, respectively), O Rh(+) samples with HLA-B*51 had the highest frequency (0.06). CONCLUSION: According to haplotype frequencies HLA-A*02-B*51-DRB1*11 is also found at higher frequencies in Bulgarian and Armenian populations. In case of HLA-associated diseases, the east Anatolian population could be susceptible to myastenia gravis, Behçet's disease, and systemic sclerosis due to the high frequencies of HLA-A*24, HLA-B*51, and HLA-DRB1*11 respectively. We did not observe a correlation between blood group antigens and HLA alleles or haplotypes in renal dialysis patients.

Living donor liver transplantation for alveolar echinococcus is a difficult procedure.

Surgical resection is the best treatment for early stage alveolar echinococcosis of the liver. In the stages that are not appropriate for resection and when the case develops complications, a liver transplant can be a lifesaver. The liver transplants of alveolar echinococcosis are technically difficult because of prior operation, interventional radiological procedures, and large mass. Despite such difficulty, living donor liver transplantation can save one's life.

Is routine sternotomy necessary for organ recovery from deceased donors? A comparative retrospective study.

BACKGROUND: Traditionally, sternotomy and laparotomy are performed to recover thoracoabdominal organs from deceased donors; however, recovering abdominal organs without sternotomy is possible. We evaluated and compared organ recovery from deceased donors, with and without sternotomy. METHODS: Between February 2006 and November 2011, organ recovery was performed in 68 deceased donors by our transplantation team. The recovery procedure was carried out using standard techniques in 31 donors (with sternotomy; Group A) and with modified techniques in 37 donors (without sternotomy; Group B). Average age, gender, body mass index (BMI), and time to cold ischemia were compared retrospectively in both groups. The demographic and clinical parameters were compared using a Student t test and chi-square test. The level of statistical significance was set at P < .05. RESULTS: Organ recovery was performed on 31 of 67 (45.6%) deceased donors with sternotomy (Group A) and 37 of 67 (54.4%) without sternotomy (Group B). Thirty-six donors were male and 32 were female. The average donor age was 40.4 ± 3.4 years in Group A and 52.4 ± 4.6 years in Group B (P < .02). The average BMI of donors was 26.2 ± 0.8 kg/m(2) in Group A and 23.9 ± 0.8 kg/m(2) in Group B. The average time to cold ischemia was 127 ± 6.2 minutes in Group A and 47.5 ± 1.8 minutes in Group B (P < .0001). CONCLUSION: The transition time to cold ischemia can be shortened by harvesting organs without sternotomy in unstable donors, or under conditions in which intrathoracic organs are not recovered.

Incidental appendectomy in donors undergoing hepatectomy for living-donor liver transplantation.

BACKGROUND: The aim of this study was to investigate the morbidity associated with appendectomy in living liver donors undergoing hepatectomy. METHODS: The medical records of 338 donors who underwent hepatectomies for living-donor liver transplantation between 2008 and 2010 were reviewed retrospectively. The patients were divided into 2 groups on the basis of appendectomy: patients in group A (n = 126) received incidental appendectomies in conjunction with donor hepatectomy, and those in group B (n = 212) underwent hepatectomy alone. RESULTS: No significant difference in age, gender, or body mass index was found between groups. The wound infection rate (P = .037) and length of hospital stay (P = .0038) were higher in group A than in group B. Intraoperative findings in 126 donors in group A were subserosal (n = 4), retrocecal (n = 6), or hard nodular (n = 11) appendix; hyperemic appendix with edema (n = 9); appendix length ≥ 8 cm (n = 18); and palpable fecalith (n = 78). Histopathologic examination of appendix specimens revealed lymphoid hyperplasia with a fecalith (n = 32), fecalith only (n = 32), acute appendicitis (n = 20), normal anatomy (n = 18), fibrous obliteration (n = 9), lymphoid hyperplasia (n = 9), Enterobius vermicularis (n = 3), appendiceal neuroma (n = 1), carcinoid tumor (n = 1), and mucoceles (n = 1). CONCLUSION: Although incidental appendectomy increased the wound infection rate and length of hospital stay, this procedure is necessary for the prevention of potential complications due to appendicitis when the exploration of the ileocecal region in patients undergoing donor hepatectomy reveals one or more of the following: appendix length ≥ 8 cm; dropsical, hyperemic, subserosal, nodular, and/or retrocecal appendix; and/or palpable fecaloma.

Can an extended right lobe be harvested from a donor with Gilbert's syndrome for living-donor liver transplantation? Case report.

Gilbert's syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient's selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1-2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is >30%. Livers with GS can be used successfully as grafts in LDLT recipients.

A kidney transplant center's initial experiences in eastern Turkey.

OBJECTIVES: Kidney transplantation is the best treatment method associated with improved quality of life and better survival for patients with end-stage renal disease. We started performing kidney transplantations in November 2010. We have performed 19 kidney transplantations so far. Fourteen of these were from living donors and five from deceased donors. Here, we present our initial experiences with 14 kidney transplant recipients from living donor kidney transplantations. MATERIALS AND METHODS: All recipients and their donors underwent detailed clinical history and examination. Recipients and their donors were followed in the transplant clinic during hospitalization. RESULTS: The male-to-female ratio was 11:3 in recipients. The mean age of recipients was 27.8 years (range 4-58 years). The number of the related, emotionally related, and unrelated transplantations were 9, 3, 2, respectively. The mean warm ischemic time was 95.7 seconds (range 52-168 seconds). Urine output started immediately after vascular anastomosis in all. The mean time of discharge from hospital was postoperative day 8 (range 4-18 days). The mean flow up was 125 days (range 18-210 days). Graft survival was 100% in this period, but one patient died from sepsis after 56 days. No kidney was lost from rejection, technical causes, infection, or recurrent disease. CONCLUSION: If transplant centers are as equipped and experienced as ours, kidney transplant programs should be started immediately so that they can reduce the number of the patients in waiting list for kidney transplantation.

En bloc and dual kidney transplantation: two initial cases from a new kidney transplantation center.

AIM: The aim of this study was to share our initial successful experiences with en bloc dual kidney transplantation. CASES: En bloc kidney were obtained, for case 1 from a 3-year-old deceased pediatric donor who had undergone cadaveric liver transplantation due to fulminant hepatitis A virus infection 1 week prior. The donor length was 97 cm and weight 13 kg. According to the age and weight of the donor, we selected a 50-year-old respectively. For case 2, a kidney was retrieved from a 20-month-old pediatric donor after development of hypoxic brain injury secondary to status epilepticus. The donor length and weight were 75 cm and 13 kg respectively. A 30-year-old female patient was of 162 cm and 59 kg. The suprarenal aorta, suprarenal vena cava, and caval and aortic lumbar branches were closed with running sutures during the backtable procedures. After the classic Gibson incision, the donor aorta was anastomosed to the recipient right common iliac artery, and the donor inferior vena cava to the recipient right common iliac vein in end-to-side fashion. The ureters were implanted with mucosa-to-mucosa ureteroneocystostomies separately according to the Lich-Gregoir technique. After the vascular anastomoses the kidneys had immediate good perfusion in both cases. Postoperative recovery was rapid, the recipients were discharged uneventfullly. CONCLUSION: En bloc dual kidney transplantation from young pediatric patients to adult recipients can be performed with low mortality and morbidity even by new centers.

Hepatic vein stenosis developed during living donor hepatectomy and corrected with peritoneal patch technique: a case report.

An 18-year-old male living donor for his father with end-stage liver cirrhosis due to hepatitis B underwent an extended right lobe donor hepatectomy. The middle hepatic vein was visualised on the cut surface of the graft and dissected up to the confluence of the middle and left hepatic veins. After vascular clamping, right and middle hepatic veins were cut to removed the graft. While starting the stump closure, the clamp over the middle hepatic vein slipped and the vein stump sutured quickly under suboptimal exposure. Soon after this closure, the remnant liver showed increasing congestion. Intraoperative Doppler ultrasound revealed obstruction of venous outflow at the remnant left liver due to stenosis in the left hepatic vein. Under total hepatic vascular occlusion, the sutures were removed from the narrowed left hepatic vein. A 2 × 2 cm peritoneal patch from the subcostal area that was prepared to close the defect was sutured to the edges of the left hepatic vein defect. Venous congestion of the liver disappeared when the clamps were removed. Intraoperative Doppler ultrasound confirmed normal hepatic venous flow. The postoperative course of the donor was uneventful. There was no clinical, biochemical, or radiological problems at 47 months of follow-up. An autogenous peritoneal patch may be a good option to repair vascular defects, which are not suitable for primary sutures, due to easy accessibility and size adjustment, cost effectiveness, as well as relatively low risk of infection and thrombosis. Close dissection of the left hepatic vein during parenchymal transection over the middle hepatic vein can result in narrowing, particularly at the bifurcation of the middle/left hepatic veins that can cause congestion in the remnant liver. When we include the middle hepatic vein with the right graft, we now believe that dissection away from the left hepatic vein seems much more secure for donors.

Surgical treatment of phytobezoars causes acute small intestinal obstruction.

PURPOSE: Our aim was to perform a clinical analysis of small intestinal obstructions caused by surgically treated phytobezoars. METHODS: Twenty-four patients, with small intestinal obstructions caused by phytobezoars, underwent surgery in our department between 1998 to 2008, were reviewed retrospectively. RESULTS: Twenty (83.3%) of 24 patients had previous gastric surgery. Preoperative computed tomography (CT) was performed in nine patients and seven (77.8%) patients, showed results consistent with a bezoar and subsequently, underwent surgery on the same day. The remaining patients had no preoperative diagnosis of a phytobezoar were typically followed-up for postoperative adhesion intestinal obstruction. Only those patients who showed no response to nonoperative treatment options underwent surgery. The phytobezoar was fragmented and milked into the cecum in 11 (45.8%) patients or extracted via longitudinal enterotomy in 12 (50%) patients; the remaining patient (4.2%) was treated via laparoscopy. Three patients had gastric phytobezoars, which were extracted via gastrotomy. There was no postoperative mortality. Two patients with previous enterotomy had either postoperative wound infection or wound infection and evisceration. CONCLUSIONS: Phytobezoars should be considered in the differential diagnosis of acute small intestinal obstruction in patients with prior gastric surgery, poor dentition, or consume fiber-rich foods. Abdominal CT is useful for both diagnosis and for the decision to perform emergency surgery. When possible, the phytobezoar should be fragmented and milked into the cecum. Laparoscopic fragmentation may be useful in such cases (Tab. 3, Ref. 28). Full Text (Free, PDF) www.bmj.sk.

Perforated hepatic hydatid cyst into the peritoneum with mild symptoms.

Rupture into the abdominal cavity is a rare but serious complication of hydatid disease that necessitates emergency surgical intervention. We present herein a case with mild abdominal symptoms due to hydatid cyst rupture into the peritoneum after trauma. A 24-year-old man was admitted to the emergency room with mild abdominal pain. His symptoms had started after a fall four days earlier. Ultrasonography and computed tomography showed cystic lesions in the liver and peritoneum with intraabdominal free fluid. He was treated surgically with partial cystectomy and falciformoplasty. Postoperative albendazole therapy was given for two months. There was not recurrence four months postoperatively at control computed tomography.

Effect of steroid on mitochondrial oxidative stress enzymes, intestinal microflora, and bacterial translocation in rats subjected to temporary liver inflow occlusion.

Protective effects of steroids against ischemia-reperfusion (I/R) injury are well known, but there is little information about the influence of temporary inflow occlusion on intestinal barrier function or bacterial translocation. The aim of this experimental study was to investigate the effects on liver, kidney, spleen, ileal mitochondrial stress enzymes, and bacterial translocation of methylprednisolone (MP) in rats undergoing temporary liver inflow occlusion. Twenty-seven pathogen-free Wistar albino rats were randomized into three groups: group A: I/R (n = 10); group B: I/R + MP (n = 10); and group C: sham (n = 7). Rats in groups A and B were subjected to 20 minutes of portal vein and hepatic artery occlusion with 3 mg/kg MP injected into group B animals intraperitoneally during the occlusion. Twenty-two hours later, all rats were sacrificed to measure mitochondrial oxidative stress enzymes in liver, kidney, spleen, and ileum. We evaluated intestinal bacterial counts, intestinal mucosal histopathology, bacterial translocation to mesenteric lymph nodes (MLN), liver, spleen, and kidney. Decreased levels of malondialdehyde and increased levels of glutathione were observed in all examined tissues of group B compared to those of group A rats. Statistically significant increases in the intestinal counts of Klebsiella spp and Proteus spp and of bacterial translocation to liver, kidney, spleen, and MLN were measured in group B with respect to group A.