Donor Kidney With Complete Duplication of Ureter: Is It Safe for Transplantation?

Renal transplantation is the best modality of treatment for patients with end-stage renal disease. Donor shortage remains a substantial problem, for which different strategies are employed, including acceptance of marginal donors and donor kidneys with anatomic variations. We performed a successful kidney transplant of a donor kidney that had complete duplication of the ureter. After transplant, the recipient had no urinary complications.

Steroid-Sparing and Steroid-Based Immunosuppression in Kidney Transplant: Is There a Difference in Outcomes and Recipient Comorbidities?

OBJECTIVES: Corticosteroids are fundamental to immunosuppression in kidney transplant but have significant side effects, generating interest in steroid-sparing immunosuppression regimens. We studied corticosteroid withdrawal on graft outcomes and comorbidities to study individualized approaches for immunosuppression. This is the first study of its kind in our ethnically distinct population. MATERIALS AND METHODS: Of 103 consecutive Saudi kidney transplant recipients seen in our unit during 2014-2018, 102 passed screening; 32 received no oral steroids after immunosuppression induction (steroid-spared group) and 70 received standard steroid-based immunosuppression. Both groups had similar immunosuppression induction: the standard steroid based immunosuppression included oral prednisolone (30 mg tapered to 5 mg over 6 wk), tacrolimus, and mycophenolate mofetil; however, the steroid-spared group did not receive corticosteroids after methylprednisolone induction. The Mann-Whitney U test compared numerical data, and the Fisher exact test compared categorical data. Relative risks for adverse events, graft dysfunction, and high serum creatinine were calculated. P < .05 was considered significant. RESULTS: Compared with the steroid-based group, patients in the steroid-spared group were older, had higher mean body mass index, and more favorable human leukocyte antigen matching and panel reactive antibody profiles. Mean serum creatinine and proportion of recipients with above normal serum creatinine were greater in the steroid-based group; this group also had slightly higher incidence of acute rejection. No graft failures or recipient deaths occurred in either group. The steroid-based group had significantly greater weight gain than the steroid-spared group (67% vs 34%; P = .002). The steroid-spared group exhibited better control of blood pressure and serum lipids; however, this was not statistically significant. CONCLUSIONS: Early steroid withdrawal in selected transplant recipients is a viable option for immunosuppression, with no compromised graft function or survival shown in our cohort. Given the significant impact of weight gain, blood pressure, and serum lipids on recipient morbidity and mortality, a larger study is warranted.

Linguistic Factors in Arabic for Miscommunication of Medication Names.

A commentary and analysis on the miscommunication of medication names between native Arabic-speaking patients and pharmacists with a native English-speaking family physician using Medical English as a Lingua Franca (MELF), in a healthcare context. An important cause of communication difficulties is the different way native English and native Arabic speakers linguistically process medication names when using MELF. This is likely to be explained by the differences in the native grammars of English and Arabic which determine differences in pronunciation and predict potential error prone groupings of letters and sounds. This in turn leads to repeating linguistic errors such as epenthesis (insertion of additional vowels between consonants) and metathesis (the swapping of adjacent consonants). The article highlights a case where both epenthesis and metathesis occur simultaneously leading to a potential serious adverse event through a medication error and suggests further avenues of research to minimise such errors.

Implantation Warm Ischemia Time in Kidney Transplant Recipients: Defining Its Limits and Impact on Early Graft Function.

BACKGROUND Prolonged cold ischemia is an established risk factor for poor early graft function (EGF). However, warm ischemia incurring during graft implantation has received little attention regarding its possible detrimental effect on EGF. The aim of our study was to examine the impact of recipient warm ischemia time on EGF. MATERIAL AND METHODS The data of 102 consecutive kidney transplants were analyzed to determine the association between duration of graft implantation time (IT) and EGF. Recipient IT groups were (GI) up to 45 min, (GII) 45-60 min, and (GIII) >60 min. EGF was categorized as immediate (IGF), slow (SGF), or delayed graft function (DGF). In recipients with IGF, graft function was further assessed by time needed for reduction in serum creatinine by 50% (SC50) of pre-transplant value, and serum creatinine on day 7 (SCD7). RESULTS Of a total of 102 recipients, 55 (55%) were in GI, 33 (32%) were in GII, and 14 (13%) were in GIII. Factors prolonging IT were recipient body mass index (BMI) (p=0.02) and multiple arteries in donor kidneys (p<0.01). No recipients in GI had DGF or SGF, while 2 in GII had DGF, and 5 patients in GIII had poor EGF. SC50 was significantly longer in GIII and GII versus GI (40.8±42.4 and 32.8±20.4 vs. 22.2±17.2 [p=.02, p≤.01]), respectively. Mean SCD7 was also significantly higher in GIII and GII versus GI. The mean last serum creatinine was comparable among all groups. CONCLUSIONS IT of more than 45 min was a risk factor for poor EGF, but achieved statistical significance only when it exceeded 60 min. Longer IT also significantly slowed the fall in SC50, and led to a higher SCD7. However, poor EGF and suboptimal early SC trends had little long-term effect on serum creatinine.

Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians.

Drug-induced hematological cytopenia is common in kidney transplantation. Various cytopenia including leucopenia (neutropenia), thrombocytopenia, and anemia can occur in kidney transplant recipients. Persistent severe leucopenia or neutropenia can lead to opportunistic infections of various etiologies. On the contrary, reducing or stopping immunosuppressive medications in these events can provoke a rejection. Transplant clinicians are often faced with the delicate dilemma of balancing cytopenia and rejection from adjustments of immunosuppressive regimen. Differentials of drug-induced cytopenia are wide. Identification of culprit medication and subsequent modification is also challenging. In this review, we will discuss individual drug implicated in causing cytopenia and correlate it with corresponding literature evidence.

Dual Kidney Transplantation: A Review of Past and Prospect for Future.

Kidney transplantation (KT) is one of the treatment options for patients with chronic kidney disease. The number of patients waiting for kidney transplantation is growing day by day. Various strategies have been put in place to expand the donor pool. Extended criteria donors are now accepted more frequently. Increasing number of elderly donors with age > 60 years, history of diabetes or hypertension, and clinical proteinuria are accepted as donor. Dual kidney transplantation (DKT) is also more frequently done and experience with this technique is slowly building up. DKT not only helps to reduce the number of patients on waiting list but also limits unnecessary discard of viable organs. Surgical complications of DKT are comparable to single kidney transplantation (SKT). Patient and graft survivals are also promising. This review article provides a summary of evidence available in the literature.

Orthotopic liver transplantation in hepatocellular carcinoma: comparison of results in incidental and known hepatocellular carcinoma.

Liver transplantation (LTx) is known therapy for hepatocellular carcinoma (HCC). We undertook a retrospective chart review and analysis of our experience with 19 patients with HCC who had undergone LTx between June 1995 and January 2003. We compared the results of 12 patients with known HCC (group I) with that of 7 patients with incidental HCC (group II). We found that the incidence of multifocal disease, lymphatic involvement, and tumor-free survival was not significantly different between the two groups. One patient in group I died of tumor. Patient survival was better in group II (100%), with a median follow-up of 45 months, as 4 more patients in group I (with known HCC) died of reasons unrelated to tumors, with a median follow-up of 23 months. We conclude that LTx in patients with either incidental or known HCC results in excellent tumor-free survival.

The effects of total parenteral nutrition on gastrointestinal growth and development.

Total parenteral nutrition (TPN) is vital for the nutritional support of infants with disorders of the gastrointestinal tract that prevent adequate enteral intake. Studies in adult rodents maintained on TPN have demonstrated intestinal atrophy and decreased activity of the brush border enzymes of the small bowel mucosa. We studied the effects of TPN during the phase of rapid intestinal growth and development in piglets. Matched groups of three 6-week-old weaned piglet littermates received a glucose (45 g/kg/d), amino acid (8 g/kg/d), and fat (2.5 g/kg/d) solution intravenously (IV) or by gastrostomy (GF), or were given hog chow (Chow) at an equivalent caloric value for three weeks. No differences were noted in the mean weight gain (13-15 g/kg/d), total serum protein (4.5-4.8 g/dL), BUN (9-12 mg/dL), or Hct (25% to 30%). The IV and GF animals, compared to the Chow animals, had decreased growth of the stomach, small bowel, and pancreas with decreased small bowel mucosal disaccharidase activity. The IV group, compared to Day 0 animal measurements, had decreased small bowel length and weight and pancreatic weight. Histology of the proximal small bowel mucosa in the IV animals showed decreased mucosal depth, villus height, crypt depth, and epithelial cell number from the crypt base to the midvillus. These findings suggest that stomach, small bowel, and pancreatic growth are dependent on the route of administration and/or the composition of the diet, the small bowel mucosa and the pancreas atrophies in young piglets maintained on TPN, the activity of some intestinal brush border disaccharidases are decreased in the small bowel in piglets maintained on either an intravenous or an intragastric infusion of a TPN solution.

Vaginal hemangiopericytoma: a histopathologic and ultrastructural evaluation.

The hemangiopericytoma is an uncommon stromovascular neoplasm that arises from the pericyte of Zimmerman. Since their original description in the female genital tract in 1954, the majority of these lesions have been of uterine origin. Presented is a clinicopathologic description of a hemangiopericytoma arising in the vagina and occupying the rectovaginal septum. Light and electron microscopic characterization is rendered. Current understanding of these lesions is reviewed and therapeutic options are discussed.