Simultaneous transabdominal bilateral nephrectomy in potential kidney transplant recipients.

BACKGROUND: Bilateral nephrectomy of potential kidney graft recipients is indicated for patients with recurrent infections in the polycystic kidneys or chronic pyelonephritis resulting from vesicoureteric reflux. The aim of this study was to analyze the frequency of complications after simultaneous bilateral transperitoneal nephrectomy. PATIENTS AND METHODS: Twenty hemodialysis patients (age 28 to 55 years) were referred for simultaneous bilateral nephrectomy between 1996 and 2004. Among the 18 patients with autosomal-dominant polycystic kidney disease, 11 experienced recurrent cysts or urinary tract infections and two, episodes of disabling flank pain. Five patients with extremely enlarged kidneys were asymptomatic. Two patients presented vesicoureteric reflux with chronic pyelonephritis. In all cases the kidneys were removed transperitoneally via a transverse or midline incision. RESULTS: Although no fatal outcome was recorded, three patients required brief hospitalizations in the intensive care unit. The only intraoperative complication was spleen injury in five patients. Surgical postoperative complications developed in nine patients (45%) including: extended drainage and delayed wound healing (n = 4), postoperative hernia (n = 3), prolonged abdominal pain (n = 3), perihepatic hematoma (n = 2), stress duodenal ulceration (n = 1), and subileus (n = 1). Five patients displayed thrombosis of their dialysis access, probably as a consequence of low blood pressure. After surgery 15 patients were placed on the waiting list and 10, successfully transplanted. CONCLUSION: Simultaneous transabdominal bilateral nephrectomy was associated with a high risk of postoperative complications, but may save the suffering associated with a repeated operation in potential kidney graft recipients who have an indication for bilateral nephrectomy.

Evaluation of transplantation procedures acceptance among students of Thai, American, and Polish origin who finished a basic didactic course.

The aim of this paper was to compare acceptance of basic transplantation procedures as displayed among students from Poland, Thailand, and the United States who finished their education in our clinic. The research concerned a group of 110 fifth year students of the medical department, including 42 citizens of Poland (group 1), 41 citizens of Thailand (group 2), and 27 citizens of the United States (group 3). The average age of the respondents was 25.4 years and 58% were women. After completing a number of clinical transplantation classes, we performed an anonymous poll that consisted of 12 questions related to attitudes toward organ donation and transplantation from dead of living donors. Chi-square tests were used to analyze the relationship between expressed opinions and demographic data. The majority of students accepted organ donation from either dead (92% "definitely yes") or living (81%) donors. The smallest percentage (58%) was expressed by group 2. Some insignificant differences were also observed in connection with the question of whether "brain death" is equivalent to death of a person. Students' responses were diverged with regard to consideration of implied consent as a factor to condition organ procurement from dead donors. Amid Thai students, acceptance was definitely lower (23%) than Polish (67%) or American (58%) ones. At the same time, organ donation was mostly dependent on the consent of a deceased person's family. Similar to other groups, the great majority of students declared their consent to both organ procurement after their own death, to donating a kidney to their relatives, or to persons with whom they are emotionally connected. Interestingly, 16% accepted organ donation for money.

Biliary complications after orthotopic liver transplantation: a 5-year experience.

INTRODUCTION: Biliary complications, particularly bile duct stenosis or leak, remain the "Achilles' heel" of orthotopic liver transplantation (OLT), significantly increasing the risk of graft loss and recipient death. The aim of the study was to retrospectively analyze biliary complications over a 5-year experience seeking to identify risk factors for these complications. MATERIAL AND METHODS: Eighty-seven OLT performed in 84 recipients were included in the analysis. In all cases but one, we performed an end-to-end hepatic duct anastomosis with a 7-0 running suture under 2.5× magnification. RESULTS: Biliary complications developed after 17.2% OLT: anastomosis site stenosis (10.3%), multiple stenoses (5.7%), or bile duct necrosis (1.1%). A bile leak was not observed. Two recipients died from biliary sepsis. Among the patients with biliary complications, there was an higher rate of hepatic artery problems (33.3% vs 2.7%; P<.01), and a longer anhepatic phase (85 vs 72 minutes; P<.01). We performed endoscopic treatment in 73% and percutaneous drainage in 6.6% of recipients. Good treatment results were achieved in 36.4% of cases with biliary complications whereas they were satisfactory in 27.3%. Five patients with biliary complications required re-transplantation. CONCLUSIONS: A bile duct anastomosis performed end-to-end with a running suture under magnification decreased the risk of bile leakage after OLT. A prolonged anhepatic phase or an hepatic artery thrombosis or stenosis increased the risk of biliary complications after OLT.