Pediatric en bloc kidney transplant from donors <15 kg: An excellent approach to expand the pediatric deceased donor pool.

INTRODUCTION: Most kidneys from small pediatric donors are transplanted to adult recipients because of the perceived risk of surgical complications and graft thrombosis. In this study, we aim to demonstrate our favorable outcomes in transplanting pediatric kidneys from donors <15 k into pediatric recipients. METHODS: This study retrospectively analyzes the outcomes of seven pediatric recipients of en block kidney transplants from pediatric donors weighing <15 kg performed at King Fahad Specialist Hospital-Dammam from December 2014 to January 2018. Baseline characteristics of donors and recipients were collected. The incidences of surgical complication, immediate, and intermediate graft function were the primary outcomes. RESULTS: The study included seven recipients monitored for a mean duration of 6.86 ± 1.35. Donors' and recipients' mean weights were 7.4 ± 3.2 kg and 20.7 ± 9.2 kg, respectively. Ureteric stricture occurred in one patient. There was a substantial improvement of 1-year estimated glomerular filtration rate (eGFR) compared to the 1-week mark (106.7 ± 26.38 mL/min. 1.73 m2 vs. 63.7 ± 22.92 mL/min/1.73 m2, p = .0069). The observed improvement in renal function persisted at the 5-year mark and during the last follow-up, with eGFR of 70.3 ± 40.7 mL/min/1.73 m2, and 79.8 ± 30.8 mL/min/1.73 m2, respectively. There was also increase of 27.9% in the size of the en bloc kidney observed at the 6 months. CONCLUSION: In a specialized transplant center with highly skilled surgeons, the utilization of en bloc kidney transplant from donors weighing less than 15 kg is an effective strategy for expanding the donor pool and ensuring favorable graft outcomes.

Salvage liver transplantation after resection of colorectal cancer liver metastasis with favorable outcomes: a case report and review of the literature.

BACKGROUND: Approximately 50% of patients with colorectal cancer (CRC) develop metastases most commonly in the liver. Liver transplantation (LT) can be used in certain cases of primary liver malignancy or in metastatic diseases, such as Neuroendocrine tumors. However, there are controversies regarding LT as a treatment option for liver metastasis from CRC due to poor outcomes in previously reported cases. CASE PRESENTATION: We report a 37-year-old male who underwent resection of the left-sided colon due to cancer and was found to have synchronous liver metastasis for which he received chemotherapy. Later, he underwent a right hepatectomy, which was complicated by insufficient liver remnant function despite the preserved liver perfusion. Therefore, salvage liver transplantation was performed successfully with a good long-term outcome. CONCLUSIONS: Many studies examined the survival and quality of life in patients undergoing liver transplantation for unresectable colorectal liver metastasis; these studies include the SECA Study (secondary cancer) and others with favorable outcomes. We reviewed the literature and compared the outcomes of some of these studies in this article. Our case emphasizes that liver transplantation could be an option for some colon cancer liver metastasis (CLM) patients, specifically, as a salvage procedure. Thus, more research is needed to develop selection criteria for patients who may benefit from liver transplantation.

Laparoscopic Donor Nephrectomy of Dual Renal Artery Kidneys: Single Center Experience.

Background: Multiple renal artery (MRA) kidneys represent a special challenge for surgeons, during both donor nephrectomy and renal transplantation. AIMS: This study aims to evaluate both donors and recipients outcomes of laparoscopically procured dual renal artery (DRA) kidneys. Patients and Methods: We reviewed the medical records of all living kidney donors who underwent laparoscopic donor nephrectomy between April 2009 and December 2014, and their recipients. Operative details and immediate outcomes of both donors and recipients of DRA kidneys were compared to those of donors and recipients of single renal artery (SRA) kidneys. Results: From a total of 250 laparoscopic donor nephrectomies, 43 (17.2%) were on kidneys having DRAs. The mean operative time was statistically higher in the group with DRA (168.1 mins vs 135.3 mins, p=0.001), however, mean warm and cold ischemia times were the same. There were no complications reported among donors in neither groups, nor conversion to open nephrectomy. Lengths of hospital stay of the donors were similar in both groups. There was no statistically significant difference in immediate allograft function among the two groups. Conclusions: Laparoscopic procurement of kidneys with dual renal arteries is safe, reliable, and has no significant impact on the neither donor's outcome, nor allograft function.

Expanding the Donor Pool to the Ultimate Level: Introducing the Revolutionary Hybrid Dual Graft Liver Transplant Using Domino and Living Donors.

Background: Innovative solutions are crucial as the demand for liver transplants continues to outpace available grafts. Dual graft liver transplantation offers a promising avenue to address graft volume challenges while minimizing donor risks. This report introduces a groundbreaking approach, combining a full organ domino donor graft with a living donor graft for a hybrid dual graft liver transplant. Brief Report: A 2-y-old child with Maple syrup urine disease and a 40-y-old adult with end-stage liver disease became the focus of this unique case. A hybrid dual graft liver transplant was executed, uniting the domino donor's full organ graft with a living donor's left lateral segment. Precise vascular and biliary reconstructions facilitated a successful transplant. Conclusions: The hybrid dual graft liver transplant, merging domino donor and living donor grafts, presents a viable strategy to combat graft shortages, particularly in regions predominantly reliant on living donor transplants. Despite challenges, this pioneering approach should be embraced by established liver transplant centers because it enables concurrent living donor liver transplantation while prioritizing donor safety and recipient outcomes.

Groundbreaking Dual-Graft Living Donor Liver Transplant Utilizing Full Right and Left Lateral Lobe Grafts: A Landmark Debut in the Kingdom of Saudi Arabia.

We introduce and documentthe first case of dual-graft living donor liver transplant, at the King Fahad Specialist Hospital in Dammam, Kingdom of Saudi Arabia, in which both a full right lobe and a left lateral segment graft were used. Our patient, a 63-year-old male, was diagnosed with nonalcoholic steatohepatitis cirrhosis and hepatocellular carcinoma involving segment 7 and selected for living donor liver transplant. Donor selection, graft volume assessment, surgical planning, procurement, and implantation of the dual grafts were meticulously executed. The first donor had an estimated right lobe volume of 639 mL, yielding an estimated graft-to-recipient weight ratio of 0.68. A liver biopsy revealed 3% macrosteatosis.The second donor's contribution comprised a left lateral segment volume of 280 mL.The decision was made for dual-graft liver transplant. With both grafts, the volume totaled 919 mL, representing graft-torecipient weight ratio of 0.98. Surgical techniques involved anastomoses of hepatic veins, portal veins, arteries, and biliary reconstruction. Both donors and the recipient were closely monitored posttransplant. After the procedure, both donors recovered swiftly and were discharged 4 days postoperation. The recipient experienced a smooth postoperative course, spending 4 days in the intensive care unit and discharged on day 26 posttransplant. This pioneering dual-graft living donor liver transplant showed successful outcomes and highlighted the potential of this approach to expand the limited donor pool, particularly in regions relying predominantly on living donors, like Saudi Arabia. This innovative surgical technique offers a promising solution to address the growing demand for liver transplants while ensuring safety for individual donors and maintaining acceptable recipient outcomes. Further exploration and adoption of dual-graft liver transplant could significantly affectthe field of livertransplant globally.

Paired Exchange Liver Transplantation Using an Altruistic Living Donor: First Case in Saudi Arabia-A Case Report.

Paired exchange (PE) living donor organ transplantation is an innovation designed to expand the pool of organs available for transplantation. In PE liver transplantation, the donor organs are exchanged between the 2 pairs to overcome blood group incompatibility or volume mismatch. There are ethical and logistic issues surrounding PE. This is the first report of PE liver transplantation in Saudi Arabia using an altruistic donor (AD). The AD may facilitate the exchange because there is no reciprocal expectation of transplantation from the AD. Paired exchange may increase only a small number of donated liver allografts. This may be the only solution for some families and in some countries.

Modified surgical reconstruction technique for a rare isolated congenital sternal cleft: In a six -year-old child.

We report the modified surgical reconstruction technique for correction for a large isolated congenital sternal cleft in 6 years old girl using a methyl methacrylate marlex mesh sandwich plate (MMS). The patient was referred to our tertiary care institution with a sizeable anterior chest wall bony defect. There was a large bulging under the skin due to protrusion of mediastinal viscera and visible cardiac pulsations with breathing. A chest x-ray and computed tomographic scan (CT) of the thorax was done to evaluate the bony defect. We reconstructed the sternal bony defect by our innovative technique using methyl methacrylate. The patient was discharged after three days for further follow up in outpatient. One year follow up patient is doing well with excellent results. Our technique is simple, cost-effective, and provides a perfect cosmetic effect for children's sternal large defects. INTRODUCTION: Sternal clefts are rare congenital malformations that result from the defective embryologic fusion of paired mesodermal bands in the midline. This rare anomaly incidence is 1:100,000 cases per live births, which constitute 1% of all congenital chest wall deformities. The first Case of the sternal cleft was reported in 1740. The hereditary sternal gap is rare, and hence sporadic cases have been reported in the medical literature. Ravitch described that the first surgical correction was reported by Lannelongue et al., in 1988., But Burton published the first successful repair in 19474. An isolated sternal cleft is a rare entity and is classified into two categories' complete and incomplete sternal gap. Early repair is recommended; otherwise, surgical correction is challenging in children as the hypo plastic sternal edges cannot be approximated primarily, and this requires prosthetic, autologous grafts or some kind of parasternal chondroplasties. CASE PRESENTATION: Since birth, a six-year-old girl was referred to our tertiary care center with a large central chest wall defect. She was a full-term normal delivery with no other congenital malformations. The defect was noticed at birth and became more evident as she grew up. In addition to cosmetic concern on coughing, there was bulging under the skin and visible cardiac pulsation. On examination, there was a large gap (7cm) in the midline of the chest with sternal adages well apart, moving independently. DISCUSSION: The sternal cleft is a congenital anomaly with less than 0.15% and is more common in the female gender. Isolated sternal cleft without any other associated abnormalities is very rare. It has been reported as a part of defined syndromes like PENTALOGY OF CANTRELL, VACTREL, DANDY WALKER, and PHASE (Posterior fossa brain malformation, hemangioma, arterial lesions, cardiac abnormalities, and eye abnormality).6 Embryo logically sternum originate from the somatic layer of lateral mesodermal plates as bilateral bands. They fuse in the midline by the 10th week to constitute a cartilaginous framework of manubrium, sternum, and xiphoid process. Failure of this fusion can lead to a partial or complete sternal cleft.7 Etiology of this disease is unknown; however, it has been linked with riboflavin or methyl-cobalamin deficiency, high alcohol intake during pregnancy. CONCLUSION: in conclusion, our improvised reconstruction technique for large sternal cleft in children has several advantages. There is no need to do extensive chordotomies or using bone grafts. Less complicated procedure Provides more rigid frame for protection of thoracic structures and better chest wall stability. Hospital stay is minimal and is very cost-effective. The child's future growth is not affected as ribs and costal cartilages are left intact in this technique. There is no chance of displacement or excursion of the MMS plate. In female patients, this provides better cosmoses as there is no need to mobilize the pectoralis significant muscles flaps for coverage. The geometry of the rib cage is well preserved.

En Bloc Transplantation of Horseshoe Kidney from Deceased Donor: An Unusual Transplantation Utilizing Kidneys with Congenital Fusion Abnormality.

Transplanting horseshoe kidneys is challenging and has higher complication rates due to the unusual anatomy of the vascular and urinary collecting systems. Most centers avoid using these kidneys for transplantation. However, if chosen carefully, these organs can be used successfully to reduce organ shortage. In this paper, we will describe the technique of procurement of horseshoe kidneys from cadaveric donors, back table preparation, and its successful implantation in a recipient. With good planning and skillful surgical techniques, horseshoe kidneys can be successfully transplanted in suitable recipients. If properly selected, these kidneys can be used to reduce the organ scarcity and diminish waitlist morbidity and mortality.

Nephrogenic Adenoma of the Urinary Bladder after Kidney Transplantation: Long-Term Follow-Up.

Nephrogenic adenoma is a rare lesion that consists of epithelial cells arranged in tubular form, resembling tubules in the renal medulla, and is found usually in the urinary bladder although it can occur anywhere in the transitional epithelium of the lower urinary tract. The first case of nephrogenic adenoma of the urinary bladder was reported before the first kidney transplantation, and the lesion has been reported in patients with and without renal transplantation. The origin of cells in nephrogenic adenoma is debated and has been postulated to arise from cells of embryonic origin or from metaplasia secondary to chronic irritation or from implantation of allograft cells in patients with kidney transplantation. The long-term outcome and potential to convert into malignancy are not established, and therefore, there are no recommendations on how to follow up these patients. We present a case of a patient who was found to have nephrogenic adenoma of the urinary bladder during his second kidney transplantation from a cadaveric donor. He had undergone living donor kidney transplantation previously which subsequently failed. The patient did not manifest any symptoms of nephrogenic adenoma. During a follow-up period of 5 years, he has not manifested any symptoms related to nephrogenic metaplasia. Histopathological examination 5 years after the second transplantation did not show any malignant change. It can be concluded that nephrogenic adenoma is likely to behave in benign fashion post kidney transplantation.

Recipient characteristics and outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam.

The success of a pediatric kidney transplantation program can only be judged by reviewing its results. We aim to audit our short-term outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam. A retrospective chart review was performed to collect data about recipient demographics, etiology of end-stage kidney disease, type of dialysis, type of donor and outcome. Between September 2008 and April 2012, 35 pediatric kidney trans-plantations (<16 year) were performed of a total of 246 kidney transplants (14.2%). The mean age was 8.1 years, with a mean weight of 23.3 kg, and there were 21 (60%) boys in the study. Kidney dysplasia/hypoplasia was the most common etiology (51.4%). Preemptive kidney transplantation was performed in six (17%) patients. Peritoneal dialysis was the most common mode of dialysis [24 (69%) children]. Living donation was the source of kidney allografts in 13 (37%) cases. During a mean follow-up of 1.5 years, one patient died and one graft was lost due to kidney vein thrombosis. The one year patient and graft survival rates were 97% and 94%, respectively. Efforts should now be focused on achieving optimal long-term results. There is also a need to encourage preemptive transplantation and living donation in this population.

Single-port laparoscopic splenectomy for idiopathic thrombocytopenic purpura.

Laparoscopic splenectomy has been performed with an average of 4 trocars since the early 1990s, and it has become the gold standard for elective splenectomy. Recently, single-port laparoscopic (SPL) surgery has emerged as an alternative to multiport laparoscopy, but SPL splenectomy in a patient with idiopathic thrombocytopenic purpura (ITP) has not been reported to date in Saudi Arabia or the region. A case report of SPL splenectomy in a patient with ITP is briefly described along with the surgical technique needed for such a procedure. The patient was an otherwise healthy 24-year-old female woman with medically refractory ITP and a platelet count of 2200. A standard splenectomy was performed using a SPL technique. The patient did well intraoperatively and postoperatively, was happy with her incision, and was discharged home with no complications 3 days after the procedure. In conclusion, SPL splenectomy is feasible in select patients and may provide a less painful, cosmetically better alternative.

Early experience with PET/CT scan in the evaluation of pediatric abdominal neoplasms.

PURPOSE: Positron emission tomography/computerized tomography (PET/CT) scan provides both functional and anatomical information in a single diagnostic test. It has the potential to be a valuable tool in the evaluation of pediatric abdominal tumors. The goal of this study is to report our early experience with this technology. METHODS: Children who underwent PET/CT scan in the workup for abdominal neoplasms between July 2005 and January 2008 were identified. Retrospective review of all radiologic studies, operative notes, and pathologic reports was undertaken. RESULTS: A total of 36 patients were collected. These included Burkitt's lymphoma (8), neuroblastoma (7), rhabdomyosarcoma (6), ovarian tumor (3), Wilms' tumor (2), hepatocellular carcinoma (2), paraganglioma (1), germ cell tumor (1), undifferentiated sarcoma (1), renal primitive neuroectodermal tumor (1), gastrointestinal stromal tumor (1), adrenocortical carcinoma (1), inflammatory pseudotumor (1), and adrenal adenoma (1). All neoplasms were fluorodeoxyglucose (FDG) were avid. Our experience identified several potential uses for PET/CT scan in this group of patients. These include (1) preoperative staging, (2) selection of appropriate site for biopsy, (3) identification of occult metastatic disease, (4) follow-up for residual or recurrent disease, and (5) assessment of response to chemotherapy. It can also be valuable when the standard diagnostic studies are equivocal or conflicting. CONCLUSIONS: Preliminary data indicate that PET/CT is a promising tool in the evaluation of pediatric abdominal malignancies. The delineation of the exact role of this diagnostic modality will require additional experience.