ABO blood group incompatible renal transplantation in New Zealand: a report of the first 20 cases.

AIM: To report on the first 20 ABO blood group incompatible (ABOi) renal transplants performed in New Zealand. METHOD: Prospective short-term data and retrospective longer-term follow-up data was collected on the first 20 such transplants between March 2008 and April 2015. RESULTS: Patient and graft survival was excellent at 95% at 12 months and final follow-up (11-85 months; median 31 months). Three serious infections were noted in this time period, one of which resulted in patient death (pneumococcal pneumonia). There were no episodes of anti-ABO blood group antibody mediated rejection. Only one patient was not able to achieve appropriate antibody reduction prior to the planned transplant. CONCLUSION: ABOi transplantation is a safe and successful treatment option for patients with end stage renal failure who cannot access an ABO compatible live donor.

Comprehensive and innovative techniques for liver transplantation in rats: a surgical guide.

AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and determined the operator learning curves. The various factors that contributed to successful surgery were determined. The most important surgical factors were evaluated between successful and unsuccessful surgeries. RESULTS: Learning curve data indicated that 50 cases were required for operator training to start a study. Operative time, blood loss, warm ischemic time, anhepatic phase, unstable systemic hemodynamic state, and body temperature after surgery significantly affected surgery success by univariate analysis, while the anhepatic phase was the most critical factor for success by multivariate analysis. CONCLUSION: OLT in rats is the only liver transplantation model that provides clinically relevant and reliable results. Shortened anhepatic phase is key to success in this model.

Assessment of 100 live potential renal donors for laparoscopic nephrectomy with multi-detector row helical CT.

PURPOSE: To retrospectively review the authors' experience with multi-detector row helical computed tomography (CT) in assessing 100 consecutive live potential renal donors. MATERIALS AND METHODS: Hospital ethical committee approval was obtained; informed patient consent was not required. One hundred potential renal donors underwent multi-detector row CT assessment. Nonenhanced, arterial phase, and nephrographic phase examinations were performed. Delayed topograms were acquired to visualize the collecting system anatomy. A vascular radiologist prospectively interpreted the multi-detector row CT images. A second vascular radiologist, blinded to the initial results, retrospectively reviewed the images. Eighty candidates subsequently underwent donor nephrectomy, including 70 laparoscopic donor nephrectomies (LDNs) and 10 open donor nephrectomies (ODNs). Surgical findings served as the reference standard for 80 kidneys. The imaging findings in all 100 candidates (200 kidneys) were reviewed, although these findings were considered observational data only because there was no reference standard for 120 kidneys. RESULTS: Multi-detector row CT findings predicted uncomplicated LDN in 67 of 70 patients. Small upper-pole capsular arteries arising from the distal main renal artery in two patients were not described in the multi-detector row CT report: In one patient, the arising vessels resulted in conversion to ODN because of bleeding; in the other patient, arterial reconstruction was performed. In another patient, conversion to ODN was necessary because of ongoing bleeding from an avulsed large lumbar venous tributary to the left renal vein. Observational data revealed that multiple renal arteries--most of which were accessory renal arteries--were seen in 52 (26%) kidneys. Early branching of the main renal artery was seen in 24 (12%) kidneys, and main renal arterial abnormalities were identified in six (3%). Capsular arteries were detected in 10 (5%) kidneys. Major variations in the anatomy of the main renal veins--including multiple right renal veins, a retroaortic left renal vein, and a circumaortic left renal vein--were seen in 28 (14%) kidneys. Large (>5 mm in diameter) systemic tributaries to the left renal vein were seen in 25 (25%) kidneys. There was no significant interobserver disagreement between the vascular radiologists. CONCLUSION: Multi-detector row CT findings can predict successful LDN in live potential renal donors.