Kidney Transplantation Using Gonadal Vein for Venous Anastomosis in Patients With Iliac Vein Thrombosis or Stenosis: A Series of Cases.

BACKGROUND: Kidney transplantation is the treatment of choice for patients with end-stage renal disease. The standard surgery uses the recipient's iliac vessels for vascular anastomosis. Thrombosis and/or stenosis of the iliac vein, which are possible complications of multiple vascular access points for dialysis, can be detected intraoperatively, constituting a surgical challenge. An infrequently reported option is the use of the gonadal vein. OBJECTIVES: This study aims to evaluate the outcomes of venous anastomosis in the gonadal vein in patients with iliac vein thrombosis and/or stenosis submitted to kidney transplantation. METHODS: We reviewed the records of five adult recipients with iliac vein thrombosis and/or stenosis detected intraoperatively during emergency kidney transplantation with deceased donor due to vascular access failure from February 2013 to December 2014. Antithrombotic prophylaxis was not performed. We evaluated the postoperative complications, length of stay, early graft echo-Doppler, and renal function during the first year postoperatively. RESULTS: Delayed graft function occurred in three cases. Two patients developed postoperative infection requiring antibiotics. One patient required reoperation due to post-renal biopsy complications. The mean length of stay was 31.2 days and the mean serum creatinine levels at discharge, at 6 months, and at 12 months postoperatively were 1.42 mg/dL, 0.86 mg/dL, and 0.82 mg/dL, respectively. All patients had normal ultrasonography. There were no losses of graft or deaths during follow-up. CONCLUSION: Venous anastomosis using the gonadal vein in kidney transplantation for patients with iliac vein thrombosis and/or stenosis showed good clinical and surgical results, showing this method to be a viable alternative to venous drainage in these complex patients.

Post-transplantation weight gain: prevalence and the impact of steroid-free therapy.

INTRODUCTION: Weight gain after renal transplantation has a multifactorial etiology, which can be associated with complications such as hypertension, dyslipidemia and diabetes, with a probable impact on cardiovascular morbidity and mortality post-transplantation. OBJECTIVE: The objectives of this study were to investigate the prevalence of weight gain and obesity post-transplantation among renal recipients of a hospital and to evaluate the impact of immunosuppressive therapy without steroids. MATERIALS AND METHODS: We have evaluated all patients who had kidney transplantations performed between January 2005 and December 2009 at General Hospital of Fortaleza, who were older than 18 years of age and had at least 12 months of follow-up post-transplantation. Overweight was defined as body mass index (BMI) between 25 and 30 kg/m(2) and obesity >30 kg/m(2). The association between weight gain and the following variables was investigated: age and gender of the recipient and the donor, donor type, steroid use, presence of systemic arterial hypertension (SAH) and diabetes mellitus, creatinine, glucose, cholesterol, and triglycerides. RESULTS: The study population included 203 recipients; 59.5% were males, their mean age systemic arterial hypertension (SAH) was 37 years, and 64.2% had deceased donors. In regard to immunosuppression, 41.3% made use of steroids. After 36 months of follow-up, the average weight gain was 6.6 kg in relation to the first month post-transplantation. Among the variables studied, the recipient's younger age and female gender, the younger donor, and the creatinine level were associated with greater weight gain after 36 months of transplantation. CONCLUSION: The percentage of weight gain was on average 9% after 36 months post-transplantation, although the prevalence of overweight and obesity increased significantly in the same period. The use of steroid therapy had no impact on the percentage of weight gain post-transplantation, and association was observed only between the younger age and the female gender of the recipient, the younger donor age, and the creatinine level with the highest weight gain post-transplantation.