At what price kidneys from complex donors while patients die on the waiting list: a word of caution.

More and more often living donors worldwide are used for kidney transplantation. The results are excellent, much better than from the deceased donors, disregarding the genetic disparity. Not surprisingly, living donation has not influenced the existing gap, and waiting lists are increasing. Live kidney donation technically has become a standardized, safe procedure. Many papers, including that from the Minneapolis Center quote follow-up results documenting that unilateral nephrectomy is safe. The Amsterdam Forum established criteria for living kidney donors. Most unfortunately, however, the continuous need for kidneys has led in the recent three years to the use of the so-called "complex" or "marginal" living donors, that is donors with metabolic syndrome. The argument for a continuous increase in living kidney donation, often used by transplant physicians, is quoted in the title of the abstract. This argument should never be used, especially by transplant physicians, who must consider the interests of both the recipient and the donor. Our own data presented at the last Congress of the Transplantation Society showed that moderate hypertension occurs in some patients. The risk of cardiovascular complications is definitely higher among donors with the metabolic syndrome, those with prediabetes, obesity, or mild hypertension. Most unfortunately there are no long-term follow-up data concerning such donors. They may require preemptive prophylaxis with step-wise interventional reno-protection and cardio-protection programs, which so far have not been implemented. For this reason, a Living Donor Registry is needed. It would allow objective assessment of the long-term risks of uninephrectomy among donors with metabolic syndrome. Such a registry is in operation in our country. Considering the use of kidney donors with the metabolic syndrome, one should remember a popular saying: "Be good, and if you cannot be good--be careful."

The assessment of residual kidney function after living donor nephrectomy.

BACKGROUND: The number of patients on the waiting list for kidney transplantation is increasing as a result of the cadaveric donor shortage. One way to expand the pool is living donor transplantation. However, only 2% of kidney transplants in Poland come from living-related donors. AIM: We sought to assess residual renal function, incidence of hypertension, and proteinuria among living kidney donors. PATIENTS AND METHODS: Between 2004 and 2007, we performed 46 living donor open nephrectomies. The mean age of the kidney donor was 39 years (range, 25-57). The donors were predominantly females (61%). Mean hospitalization time was 8 days (range, 4-22). Nine donors did not report for follow-up visits. The observation periods ranged from 1 to 24 months. Physical examination, blood and urine tests, as well as ultrasound scans were performed before nephrectomy and at every follow-up visit (1, 3, 12, and 24 months post operatively). RESULTS: Mean creatinine concentration was higher at 3 months after nephrectomy than preoperatively (P < .05). Mean creatinine clearance according to Cockroft-Gault formula and mean creatinine clearance according to abbreviated modification of diet in renal disease equation (aMDRD) decreased after donation by 30% (P < .05). No cases of proteinuria were observed. Hypertension occurred in 1 donor (2.7%). CONCLUSION: Living kidney donation resulted in a reduced creatinine clearance in the donor. Follow-up of living kidney donors is essential to determine risk factors for deterioration of residual kidney function.

Significance of urodynamic assessment of lower urinary tract in dialysis patients before renal transplantation.

INTRODUCTION: Some dialyzed patients suffer from lower urinary tract (LUT) anatomic and functional disturbances. Complete LUT assessment should be performed to decide whether they can be included on the waiting list, because such disorders, if not diagnosed and properly treated before transplant, may lead to graft loss. PATIENTS AND METHODS: Based on data in the medical records of 4170 dialysis patients, 535 were selected for further investigation: 265 patients after undergoing urethrocystography or urethrocystoscopy, were included on the waiting list for transplantation and 145 patients underwent nephroureterectomy owing to reflux, nephrolithiasis, polycystic renal disease, or hydronephrosis. Five patients with urethral or bladder neck stricture underwent urethral dilation or bladder neck incision. These patients were also ultimately listed for transplantation. Twenty-two patients, with serious LUT disease were qualified for kidney transplantation after extra-anatomic urine outflow. Ninety-eight patients underwent a urodynamic study (URD) to assess LUT disturbances. RESULTS: Of 535 studied patients, 460 (86%), including those who underwent surgical or pharmacologic treatment, were ultimately listed for kidney transplantation. Out of 98 patients who underwent a URD, 45 (46%) were included for kidney transplantation, and 47 for transplantation with atypical urinary outflow. Six patients were excluded from transplantation owing to refusal of investigations or serious contraindications. CONCLUSIONS: All potential kidney recipients should undergo proper evaluation of the LUT before being qualified for kidney transplantation. This study allows selection of patients who should undergo surgical and/or pharmacologic treatment before transplantation.

Renal transplantation in Warsaw: a registry report.

In a country undergoing socioeconomic transformation, with all the attendant financial difficulties, it is rather difficult to obtain very good results in this expensive and advanced method of therapy. However, in spite of such difficulties, the results obtained are equal to the European standards, with 85% and 65% one- and five-year graft survival, respectively.

Experimental assessment of canine pancreatic segment function.

The purpose of the study was to examine the variability of pancreatic arterial vascularization and to evaluate a vascular model of canine pancreatic segment for transplantation, providing preservation of normal endocrine and exocrine functions. The study included the assessment of pancreatic segment function on the basis of glycemia and post mortem corrosion-casts dissection.