RESUMO
PURPOSE: Surgical management of autosomal dominant polycystic kidney disease (ADPKD) in patients awaiting renal transplantation is a challenging task. METHODS: From 1998 to 2009, a total of 100 consecutive renal transplantations with simultaneous unilateral nephrectomy were performed in 59 men and 41 women with ADPKD and end-stage renal failure. About 38% received kidney allografts from living donors. The ipsilateral polycystic kidney was removed at the time of renal transplantation. Immunosuppressive therapy was not modified. Cold ischaemia time was 155 (38-204 min) versus 910 min (95-2760 min) for living versus deceased donor transplantation. Mean weight of removed kidneys was 2002 g (414-8850 g). Mean follow-up was 3.0 years (0.8-10.0 years). RESULTS: Overall patient and graft survival were 97 and 96% at 1 year and 93 and 80% at 5 years, respectively. Serum creatinine at current follow-up was 1.49 (0.8-2.8) mg/dL. Surgical complications, which might be associated with simultaneous nephrectomy requiring re-operation, occurred in 12% (lymphocele 4%, hernia 4%, post-operative haematoma or bleeding 4%). None of the patients died peri-operatively. CONCLUSION: Renal transplantation with simultaneous unilateral nephrectomy in ADPKD is a reasonable procedure for patients suffering from massively enlarged native kidneys.
Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim , Nefrectomia/métodos , Rim Policístico Autossômico Dominante/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Rim/fisiologia , Falência Renal Crônica/mortalidade , Transplante de Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Rim Policístico Autossômico Dominante/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: Identification of independent treatment factors associated with high radiation exposure during endovascular mechanical thrombectomy (EMT) in acute ischemic stroke. METHODS: This retrospective analysis included all patients treated by means of EMT during the 2year period 2017-2018 in a comprehensive stroke center. The EMT were performed by four internal and three external certified neuroradiologists in a clinic overlapping on call system. Radiation exposure as the dependent variable (dose area product DAP, Gyâ¯â cm2) was dichotomized in <â¯100â¯Gyâ¯â cm2 and ≥â¯100â¯Gyâ¯â cm2. Independent variables were age (<â¯75 years vs. ≥â¯75 years), time of intervention (during vs. beyond workday), treating neuroradiologist (internal vs. external), occlusion type ("mono" vs. "tandem"), reperfusion success (TICI 0-2A vs. TICI 2B/3), recanalization attempts (≤â¯2 vs. >â¯2) and dose protocol (normal dose in 2017 vs. low dose in 2018). RESULTS: The EMT treatment of 208 patients (111 female, 97 male, mean age 71.6 years) was analyzed. Median DAP was 86.6â¯Gyâ¯â cm2 and could be reduced from 104.8â¯Gyâ¯â cm2 (Nâ¯= 105 in 2017) to 73.3â¯Gyâ¯â cm2 (Nâ¯= 103 in 2018) with LD program. Univariable and multivariable binary logistic regression analysis revealed a significantly increased radiation exposure (≥â¯100â¯Gyâ¯â cm2) in tandem occlusion type (Pâ¯< 0.001), >â¯2 recanalization attempts (Pâ¯< 0.001) and normal dose protocol (Pâ¯= 0.002). CONCLUSION: Low dose programs can significantly reduce the radiation exposure in EMT. High radiation exposure is significantly associated with more than two recanalization attempts and in cases of tandem occlusions.