[Incidence of thrombophilia and risk of renal vessel thrombosis in kidney transplant recipients]. / A thrombophilia elofordulása és a veseerek thrombosisának veszélye veseátültetett betegeknél.

INTRODUCTION: Kidney transplantation is the optimal treatment of end stage kidney disease. The most common vascular complication in the early postoperative period is thrombosis of the renal artery and vein. These complications usually lead to the loss of the transplanted kidney. AIM: of our study was to identify those factors which represent an increased risk for thrombotic complication and determine whether routine screening for thrombophilia is justifiable before transplantation. As an illustration to this problem we report a case of successful renal vein recanalisation after thrombosis. METHODS: We give an overview of the literature about incidence of renal graft thrombosis, hypercoagulable states, predictive value of factor V. Leiden and prothrombin G20210A mutations in venous thromboembolism. We discuss those publications that suggest a preoperative screening of transplant candidates for hypercoagulable states and thrombophilia and those that do not think that such screening is reasonable. In our case a 28 year old male patient received a cadaveric kidney. Thrombosis of the renal vein was diagnosed 8 hours after transplantation. Reoperation was performed immediately: venous anastomosis was opened, the thrombus removed. After reoperation the circulation of the kidney recovered, intravenous heparin treatment was introduced immediately. RESULTS: 24 months later the kidney is still functioning well. Postoperative thrombophilia screening showed heterozygosity for factor V Leiden. CONCLUSION: There are only few publications reporting on successful recanalisation after renal vein thrombosis. In our case rapid diagnosis and immediate operative treatment saved the graft. There is no uniform proposal in the literature whether preoperative screening for thrombophilia is justifiable or not. In our view screening for thrombophilia and thromboprophylaxis is mandatory. Extensive prospective studies should be undertaken to refine the risks and establish the associations of thrombophilia and thromboembolism after kidney transplantation.

[Evaluation of patients' readiness for surgery when called from the waiting list for kidney transplantation: experience of the Budapest Centre]. / Veserecipiensek alkalmassága transzplantációra való behíváskor. A budapesti centrum tapasztalatai.

UNLABELLED: The aim of this study was to assess the impact of the establishment of waiting list committee on recipient evaluation for kidney transplantation. Studies on this issue have not been previously reported. METHODS: Data of 714 patients were collected between September 1, 2007 and April 20, 2010. Of the 714 patients 354 were transplanted. Data from the first 16 months period were compared to those obtained during the second 16 months period. RESULTS: During the first period 171 patients (47.9%) were unfit for transplantation [129 patients (36.1%) were refused after telephone information and 42 patients (11.8%) after clinical investigation]. During the second period 141 (39.5%) patients were found to be unsuitable [80 patients (22.4%) after telephone information and 61 patients (17.1)] after clinical examination. During the two periods of the study 44% of patients were unfit for transplantation. A considerable number of patients were refused because of cardiologic reasons. The percent of fit patients was 52.1% in the first period and 60.5% in the second period. In addition, the percent of unfit patients who were unsuitable for kidney transplantation after telephone information decreased from 36.1% to 22.4%, while the percent of unfit patients after clinical evaluation increased from 11.% to 17.1%. CONCLUSIONS: Authors conclude that waiting list committee made an effective work.