Posttransplant infectious complications: a prospective study on 142 kidney allograft recipients

We evaluated the posttransplant complications resulting from infections and their association with graft function, immunosuppressive drugs, and mortality. A total of 142 kidney allograft recipients were followed for 1 year after transplantation. The patients' status was assessed during regular visits, and data including clinical characteristics, infections, serum creatinine level, acute rejection episodes, immunosuppressive regimen, graft function, and mortality were recorded and analyzed. Infections occurred in 77 patients [54%]. The lower urinary [42%] and respiratory [6.3%] tracts were the most common sites of infection. The most frequent causative organisms were Klebsiella in 34 [24%] and cytomegalovirus in 25 patients [18%]. Wound infection occurred in 7 patients [5%]. The mortality rate was 7.7% and infection-related death was seen in 5 patients [3.5%] who developed sepsis. Graft loss was seen in 16 patients [11%], of whom 2 developed cytomegalovirus infection, 2 experienced urinary tract infection, and 5 developed sepsis and died. Mycobacterial and hepatitis C infections were noticeably rare [0.7% and 2.8%, respectively]. This study showed that infections are important causes of morbidity and mortality during the posttransplant period. We recommend that serologic tests be performed before and after transplantation to recognize and meticulously follow those who are at risk. In our study, high-risk patients were those with elevated serum creatinine levels who received high doses of immunosuppressive drugs. As the urinary tract is the most common site of infection, early removal of urethral catheter is recommended to reduce the risk of infection

Buccal mucosal graft in repeat urethroplasty

Our aim was to evaluate the efficacy of a tubed buccal mucosal graft in repeat urethroplasty for patients with urethral stricture and failed previous operations. Ten patients [aged 12 to 47 years] with urethral stricture were entered into the study. All had a history of failed previous urethroplasties, and 5 had failed internal urethrotomies, too. Repeat urethroplasties were performed by excising the fibrous tissue around the stricture; buccal mucosa was then harvested from the inner cheek, made into graft tubing, and interposed into the defect. The patients were followed at 1, 6, and 12 months. The procedure was technically successful in all the patients. The mean operative time was 150 minutes. The stricture sites were in the posterior urethra in 8 and the anterior urethra in 2 patients. The mean urethral defect length was 4.9 cm. The primary etiology was pelvic fracture in 7 patients. Strictures recurred postoperatively in 3 patients, all of whom had a urethral defect longer than 5 cm, and 2 of whom had more than 1 previous failed urethroplasties [compared with 1 out of 7 in the successful cases]. Urinary flow rate increased significantly [from 0 to 10.4 +/- 7.33 mL/s] postoperatively [P = .018]. Longer strictures produced signifcantly poorer graft urethroplasty outcomes [P = .001]. Urethroplasty with buccal mucosal grafts is tough, resilient, easy to harvest, and leaves no scar. It appears to be an optimal substitute for anterior and posterior urethral strictures longer than 3 cm