Successful renal transplantation after intimal dissection of the renal artery secondary to trauma.

BACKGROUND: Organ shortage increasingly forces surgeons to consider the use of marginal organs. METHODS: The authors report a case in which a kidney with traumatic dissection of the renal artery and marginal perfusion by means of collaterals was successfully transplanted into a 63-year-old patient. A computed tomographic scan of the donor showed a marginally perfused left kidney, suggestive of renal artery dissection. After surgical reconstruction of the renal artery, transplantation followed the usual course. RESULTS: The organ started clearing shortly after the operation and was homogeneously perfused in a postoperative scan. Creatinine and blood urea nitrogen levels dropped to normal values within a couple of days after the transplantation. During 1 year of follow-up, organ function was always excellent and retention parameters were within the normal range. CONCLUSIONS: This case illustrates that marginally perfused kidneys can be successfully used for transplantation in certain cases.

Mobile decision support for transplantation patient data.

In high-critical medical fields instant information delivery is essential. Task-flow analyses within the transplantation unit of the Technische Universität München revealed that valuable time could be saved in pre-transplantation management being able to retrieve data of organ receivers ubiquitously. Inspired by this clinical scenario, a mobile application was designed and implemented providing surgeons with decision-relevant information on potential organ receivers. It assists them in considering the prospects of forthcoming organ transplantations and facilitates decision making and documentation with regard to high security demands. The described system services three organ receiver lists and is used by the surgeons in every transplantation procedure. After a 6-month period of clinical usage, the system has been evaluated in terms of handling, clinical benefit and total time savings. Intuitive, ubiquitous access to decision-relevant patient data and authenticated documentation were the major improvements with average total time savings of 50 min in comparison to the old system.

Donor transmitted anaplastic carcinoma in a kidney-transplant recipient.

With the more frequent use of organs from elderly donors, the risk of transmitting tumor cells to the recipient increases. We report a case in which anaplastic carcinoma tumor cells from an organ-donor were transmitted to a kidney transplantation recipient. The donor's metastatic disease was discovered 7 days after harvest of the kidney following a brain biopsy undertaken at admission of the donor. The risk of transmitting the disease was generally estimated as so small that the excellently functioning kidney was not removed. Twelve weeks later, however, malignant cells were found in a biopsy of the transplanted kidney. The organ was removed immediately, but the intraoperative situs showed advanced disease with lymph-node-metastasis. Twelve months later no tumor progress could be detected. This case shows that there is considerable risk of transmitting formerly undetected cancer in elderly donors. Autopsies of donors who are older than 60 years of age should be routinely performed after organ donation.