ABSTRACT
Nighttime organ transplantation aims to decrease cold ischemia duration, yet conflicting data exists on its impact on graft function and perioperative complications. This multicenter TRANSPLANT'AFUF study including 2,854 patients, transplanted between 1 January 2011, and 31 December 2022, investigated nighttime kidney transplantation's impact (8:00 p.m.-8:00 a.m.) versus daytime (8:00 a.m.-8:00 p.m.) on surgical complications and graft survival. Overall, 2043 patients (71.6%) underwent daytime graft, while 811 (28.4%) underwent nighttime graft. No impact was observed of timing of graft surgery on graft survival with a median survival of 98 months and 132 months for daytime and nightime grafting, respectively (p = 0.1749). Moreover, no impact was observed on early surgical complications (Clavien I-II = 20.95% for DG and 20.10% for NG; Clavien III-IV-V = 15.42% for DG and 12.94% for NG; p = 0.0889) and late complications (>30 days) (Clavien I-II = 6.80% for DG and 5.67% for NG; Clavien III-IV-V = 12.78% for DG and 12.82% for NG; p = 0.2444). Noteworthy, we found a significant increase in Maastricht 3 donors' rates in nighttime transplantation (5.53% DG vs. 21.45% NG; p < 0.0001). In conclusion, nighttime kidney transplantation did not impact early/late surgical complications nor graft survival.
Subject(s)
Kidney Transplantation , Humans , Kidney Transplantation/adverse effects , Graft Survival , Time Factors , Retrospective Studies , Tissue Donors , Postoperative Complications/etiologyABSTRACT
OBJECTIVE: Delayed graft function (DGF) is a common complication after transplantation of deceased donor kidneys. The aim of this study was to investigate the feasibility of using computed tomography texture analysis (CT-TA) of the donor kidney to predict delayed graft function (DGF) following kidney transplantation from cadaveric donors. MATERIALS AND METHODS: We made a retrospective review of all consecutive DBD and DCD kidney donors admitted to our institution and their corresponding KTRs between December 2014 and January 2019. We extracted 15 image features from unenhanced CT and contrast-enhanced CT corresponding to first order and second order Haralick textural features. Predictors of DGF were evaluated by univariable and multivariable analysis. Receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) to predict DGF was calculated for the predictors. RESULTS: A total of 115 patients were included in the study. DGF occurred in 15 patients (13%). Recipient body mass index (BMI) (P=0.003) and Skewness (P=0.05) represented independent predictors in the multivariate model. The combination of both clinical and textural features in a bivariate model reached a ROC-AUC of 0.79 (95% CI: 0.64-0.94) in predicting the probability of DGF. CONCLUSION: Results from this preliminary study suggest that CT texture analysis might be a promising quantitative imaging tool to help physician predict DFG after kidney transplantation from cadaveric donors. LEVEL OF EVIDENCE: 4/5.
Subject(s)
Kidney Transplantation , Cadaver , Delayed Graft Function/diagnostic imaging , Delayed Graft Function/etiology , Graft Survival , Humans , Kidney , Kidney Transplantation/adverse effects , Retrospective Studies , Risk Factors , Tissue Donors , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To define guidelines for the management of renal cell carcinoma of the native kidney (NKRCC) in kidney transplant (KTx) recipients and renal cell carcinoma (RCC) in end-stage renal disease (ESRD) patients candidates for renal transplantation. METHOD: A review of the literature following a systematic approach (Medline) was conducted by the CTAFU to report renal cell carcinoma epidemiology, screening, diagnosis and management in KTx candidates and recipients. References were assessed according to a predefined process to propose recommendations with the corresponding levels of evidence. RESULTS: ESRD patients are at higher risk of RCC with a standardized incidence ratio of approximately 4,5 as compared with general population. NKRCC tumors occur in 1 to 3 % of KTx recipients with a 10 to 15-fold increased risk as compared with general population, especially in patients with acquired multicystic kidney disease. Most authors suggest yearly monitoring of the native kidneys using ultrasound imaging. Radical nephrectomy (either open or laparoscopic approach) is the preferred treatment of NKRCC in KTx recipients and RCC in ESRD. Surveillance in a valid option in small or cystic renal masses. In the localized setting, change in immunosuppressive therapy is not recommended besides perioperative avoidance of mTOR inhibitor to limit morbidity. CTAFU does not recommend a mandatory waiting time after nephrectomy for RCC in ESRD patients candidates for renal tranplantation when tumor stageSubject(s)
Carcinoma, Renal Cell/diagnosis
, Carcinoma, Renal Cell/surgery
, Kidney Failure, Chronic/surgery
, Kidney Neoplasms/diagnosis
, Kidney Neoplasms/surgery
, Kidney Transplantation
, Postoperative Complications/diagnosis
, Postoperative Complications/surgery
, Carcinoma, Renal Cell/complications
, Humans
, Kidney Failure, Chronic/complications
, Kidney Neoplasms/complications
ABSTRACT
OBJECTIVE: To propose surgical recommendations for urothelial carcinoma management in kidney transplant recipients and candidates. METHOD: A review of the literature (Medline) following a systematic approcah was conducted by the CTAFU regarding the epidemiology, screening, diagnosis and treatment of urothelial carcinoma in kidney transplant recipients and candidates for renal transplantation. References were assessed according to a predefined process to propose recommendations with levels of evidence. RESULTS: Urothelial carcinomas occur in the renal transplant recipient population with a 3-fold increased incidence as compared with general population. While major risk factors for urothelial carcinomas are similar to those in the general population, aristolochic acid nephropathy and BK virus infection are more frequent risk factors in renal transplant recipients. As compared with general population, NMIBC in the renal transplant recipients are associated with earlier and higher recurrence rate. The safety and efficacy of adjuvant intravesical therapies have been reported in retrospective series. Treatment for localized MIBC in renal transplant recipients is based on radical cystectomy. In the candidate for a kidney transplant with a history of urothelial tumor, it is imperative to perform follow-up cystoscopies according to the recommended frequency, depending on the risk of recurrence and progression of NMIBC and to maintain this follow-up at least every six months up to transplantation whatever the level of risk of recurrence and progression. Based on current data, the present recommendations propose guidelines for waiting period before active wait-listing renal transplant candidates with a history of urothelial carcinoma. CONCLUSION: The french recommendations from CTAFU should contribute to improve the management of urothelial carcinoma in renal transplant patients and renal transplant candidates by integrating both oncologic objectives and access to transplantation.
Subject(s)
Carcinoma, Transitional Cell/diagnosis , Carcinoma, Transitional Cell/therapy , Kidney Failure, Chronic/surgery , Kidney Transplantation , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Urologic Neoplasms/therapy , Carcinoma, Transitional Cell/complications , Humans , Kidney Failure, Chronic/complications , Urologic Neoplasms/complicationsABSTRACT
OBJECTIVE: To define guidelines for the management of localized prostate cancer (PCa) in kidney transplant (KTx) candidates and recipients. METHOD: A systematic review (Medline) of the literature was conducted by the CTAFU to report prostate cancer epidemiology, screening, diagnosis and management in KTx candidates and recipients with the corresponding level of evidence. RESULTS: KTx recipients are at similar risk for PCa as general population. Thus, PCa screening in this setting is defined according to global French guidelines from CCAFU. Systematic screening is proposed in candidates for renal transplant over 50 y-o. PCa diagnosis is based on prostate biopsies performed after multiparametric MRI and preventive antibiotics. CCAFU guidelines remain applicable for PCa treatment in KTx recipients with some specificities, especially regarding lymph nodes management. Treatment options in candidates for KTx need to integrate waiting time and access to transplantation. Current data allows the CTAFU to propose mandatory waiting times after PCa treatment in KTx candidates with a weak level of evidence. CONCLUSION: These French recommendations should contribute to improve PCa management in KTx recipients and candidates, integrating oncological objectives with access to transplantation.
Subject(s)
Kidney Failure, Chronic/surgery , Kidney Transplantation , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Humans , Kidney Failure, Chronic/complications , Male , Prostatic Neoplasms/complicationsABSTRACT
OBJECTIVE: To propose surgical recommendations for the management of lower urinary tract symptoms (LUTS) and urinary incontinence in kidney transplant recipients and candidates. METHOD: Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU focusing on medical and surgical treatment of LUTS and urinary incontinence in kidney transplant recipients and candidates. References were assessed according to a predefined process to propose recommendations with levels of evidence. RESULTS: Functional bladder capacity and bladder compliance are impaired during dialysis. LUTS, related to pre-kidney transplantion alterations, frequently improve spontaneously after kidney transplantation. LUTS secondary to benign prostatic hyperplasia (BPH) may be underestimated before kidney transplantation due to oliguria, low bladder compliance and low bladder capacity. In LUTS associated with BPH, anticholinergics require dosage adjustment with creatinine clearance. If surgery is indicated after kidney transplantation, procedure can be safely performed in the early post-transplant course after removal of ureteral stent. Surgical management of urinary incontinence does not seem to be associated with an icreased risk for infectious complications in kidney transplant recipients. Particular attention should be paid to the management of postvoid residual and bladder pressures in case of neurological bladder disease. Optimal care of neurological bladder should be provided prior to transplantation: with a cautious management, and despite an increased occurrence of febrile urinary tract infections, transplant survival is not compromised. CONCLUSION: These recommendations must contribute to improve the management of lower urinary tract symptoms and urinary incontinence in kidney transplant patients and kidney transplant candidates.
Subject(s)
Kidney Transplantation , Lower Urinary Tract Symptoms/complications , Lower Urinary Tract Symptoms/surgery , Postoperative Complications/surgery , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/surgery , Urinary Incontinence/complications , Urinary Incontinence/surgery , HumansABSTRACT
OBJECTIVE: To define guidelines for the management of kidney stones in kidney transplant (KTx) donor or recipients. METHOD: Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to report kidney stone epidemiology, diagnosis and management in KTx donors and recipients with the corresponding level of evidence. RESULTS: Prevalence of kidney stones in deceased donor is unknown but reaches 9.3% in living donors in industrialized countries. Except in Maastrich 2 donors, diagnosis is done on systematic pre-donation CT scan according to standard french procedure. No prospective study has compared therapeutic strategies available for the management of kidney stones in KTx donor: ureteroscopy or an extra corporeal lithotripsy in case of living donor prior to donation, ex vivo approach (pyelotomy or ureteroscopy), ureterocopy in the KTx recipient or surveillance. De novo kidney stones result from a lithogenesis process to be identified and treated in order to avoid recurrences. The context of solitary functional kidney renders the prevention of recurrence of great importance. Diagnosis is suspected when identification of a renal graft dysfunction, hematuria or urinary tract infection with renal pelvis dilatation. Stone size and location are determined by computed tomography. There are no prospective, controlled studies on kidney stone management in the KTx. The therapeutic strategies are similar to standard management in general population. CONCLUSION: These French recommendations should contribute to improve kidney stones management in KTx donor and recipients.
Subject(s)
Kidney Transplantation , Postoperative Complications/therapy , Tissue Donors , Urinary Calculi/therapy , HumansABSTRACT
AIM: Overtreatment is an actual problem in low risk localized prostate cancer (PC) management. Active surveillance (AS) is a solution to limit this problem, but eligibility criteria remained discussed. The aim was to assess possibilities of widening selection criteria for patient in AS, studying curative treatment free survival (CTFS) according to restricted or expanded eligibility criteria. METHODS: We retrospectively studied patients beginning AS between 2008 and 2014, for Gleason 6 localized PC, PSA<15ng/ml,Subject(s)
Prostatic Neoplasms
, Watchful Waiting
, Humans
, Male
, Overtreatment
, Prostate-Specific Antigen
, Prostatectomy
, Prostatic Neoplasms/surgery
, Prostatic Neoplasms/therapy
, Retrospective Studies
ABSTRACT
PURPOSE: Very few studies have sought prognostic factors after adrenalectomy for metastasis. The aim of this study was to assess prognostic factors for oncological outcomes after adrenalectomy for adrenal metastasis. METHODS: All adrenalectomies for metastases performed in seven centers between 2006 and 2016 were included in a retrospective study. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Prognostic factors for CSS and RFS were sought by Cox regression analyses. RESULTS: 106 patients were included. The primary tumors were mostly renal (47.7%) and pulmonary (32.3%). RFS and CSS estimated rates at 5 years were 20.7% and 63.7%, respectively. In univariate analysis, tumor size (HR 3.83; p = 0.04) and the metastasis timing (synchronous vs. metachronous; HR 0.47; p = 0.02) were associated with RFS. In multivariate analysis, tumor size (HR 8.28; p = 0.01) and metastasis timing (HR 18.60; p = 0.002) were significant factors for RFS. In univariate analysis, the renal origin of the primary tumor (HR 0.1; p < 0.001) and the disease-free interval (DFI; HR 0.12; p = 0.02) were associated with better CSS, positive surgical margins with poorer CSS (HR 3.4; p = 0.01). In multivariate analysis, the renal origin of the primary tumor vs. pulmonary (HR 0.13; p = 0.03) and vs. other origins (HR 0.10; p = 00.4) and the DFI (HR 0.01; p = 0.009) were prognostic factors for CSS. CONCLUSION: In this study, tumor size and synchronous occurrence of the adrenal metastasis were associated with poorer RFS. Renal origin of the primary tumor and longer DFI were associated with better CSS. These prognostic factors might help for treatment decision in the management of adrenal metastasis.
Subject(s)
Adrenal Gland Neoplasms/secondary , Adrenal Gland Neoplasms/surgery , Adrenalectomy , Metastasectomy/methods , Adrenal Gland Neoplasms/mortality , Aged , Disease-Free Survival , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: Spinal imaging in multiple sclerosis remains challenging because of its small size and numerous artifacts. OBJECTIVE: To compare 3D Phase-Sensitive Inversion Recovery (PSIR) to a conventional dataset of 3D Short Tau Inversion Recovery (STIR) and T2-weighted imaging at 3 Tesla to detect multiple sclerosis spinal cord lesions. METHODS: This prospective single-center study was approved by a national research ethics board and included 54 patients (median age 44) enrolled from December 2016 to August 2018. Two neuroradiologists individually analyzed the two datasets separately and in random order. Discrepancies were resolved by consensus with a third neuroradiologist. The primary judgment criterion was the number of spinal cord lesions. Secondary judgment criteria included location of the lesions, reader-reported confidence and conspicuity assessed with the lesion-to-cord contrast ratio (LCCR). RESULTS: 3D PSIR detected significantly more lesions than the conventional dataset (371 versus 173, respectively, p < 0.05). Seven patients had no detected lesion with the conventional dataset, whereas 3D PSIR detected at least one lesion. LCCR mean reader-reported confidence (p < 0.001) and inter-observer agreement were higher using 3D PSIR. CONCLUSIONS: 3D PSIR significantly improved overall spinal cord lesion detection in MS patients, with higher reader-reported confidence, higher lesion contrast, and higher inter-reader agreement.
Subject(s)
Multiple Sclerosis/diagnostic imaging , Neuroimaging/methods , Spinal Cord Diseases/diagnostic imaging , Adult , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Sclerosis/pathology , Prospective Studies , Spinal Cord Diseases/pathologyABSTRACT
INTRODUCTION: Local anesthesia using urethral gel has been proven to reduce discomfort of male patients during flexible cystoscopy. This study was a non-inferiority study between two lidocain-containing urethral gel (Instillagel® Lido and Xylocaine® gel). METHODS: A prospective single center study was conducted between June 2014 and November 2014. Male patients seen in the office and in whom a flexible cystoscopy was planned were included in the present study and received urethral instillation of either Xylocaine® gel or Instillagel® Lido at least 5minutes before flexible cystoscopy. No other anesthetic agent was used. Primary endpoint was pain during the procedure, assessed through visual analog scale (VAS) from 0 to 10. RESULTS: Four hundred and sixty-one men were included: 233 in the Instillagel® Lido group and 228 in the Xylocaine® gel group. Indications of flexible cystoscopy non-muscle invasive bladder cancer follow-up in 44 % of cases, hematuria work-up in 21 % of cases and lower urinary tract symptoms work-up in 35 %. Patients' age was comparable betwwen both groups: 64.5 years (±1.1) in the Instillagel® Lido group and 66.2 years (±1.1) in the Xylocaine® gel group (P=0.29). The mean VAS was 0.8 (±0.1) in the Instillagel® Lido group and 0.6 (±0.1) in the Xylocaine® gel group (P=0.10). The non-inferiority criterion was reached (P<0.001) as the average difference in VAS between the two groups was 0.2 with a confidence interval not comprising 1 (CI 97.5 %: -0.47; 0.07). CONCLUSION: In this prospective study, Instillagel® Lido was not inferior to Xylocaine® gel for local analgesia during flexible cystoscopy in male patients. LEVEL OF EVIDENCE: 4.
Subject(s)
Analgesia/methods , Anesthetics, Local/therapeutic use , Chlorhexidine/therapeutic use , Cystoscopy , Intraoperative Care , Lidocaine/therapeutic use , Pain Management/methods , Aged , Drug Combinations , Gels , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
It is well established that the dopaminergic system influences simple reaction time (RT) performance. However, the role of this system in more complex information processing remains to be clarified. The present study was aimed at addressing this issue. To this end, we used an inferential method that relies on choice RT procedures and allows one to identify information processing stages in both humans and rats. Long-Evans rats responded to lateral visual cues (left or right). Two task factors, signal intensity and foreperiod duration, were manipulated. Low doses of two pharmacological agents, SCH 23390 (a D1 receptor antagonist; 0.015 and 0.025 micromol/kg) and eticlopride (a D2 receptor antagonist; 0.01 and 0.02 micromol/kg), were administrated systemically. Both drugs increased choice RT: eticlopride interacted with signal intensity on RT, showing that D2 receptors mediate at least the sensory stage of stimulus preprocessing. In addition, eticlopride interacted with signal intensity on omission rate, thereby suggesting an involvement of D2 receptors in attentional processes; and SCH 23390 interacted with foreperiod duration on RT, indicating that D1 receptors specifically mediate the response adjustment stage. The effect of this drug on RT rests entirely in its interaction with foreperiod duration, allowing us to conclude that this D1 antagonist affects the response adjustment stage while sparing all other processing stages.
Subject(s)
Antipsychotic Agents/pharmacology , Benzazepines/pharmacology , Cognition/drug effects , Discrimination Learning/drug effects , Dopamine Antagonists/pharmacology , Receptors, Dopamine D1/physiology , Receptors, Dopamine D2/physiology , Salicylamides/pharmacology , Animals , Parkinson Disease/physiopathology , Rats , Rats, Long-Evans , Reaction Time , Receptors, Dopamine D1/drug effects , Receptors, Dopamine D2/drug effectsABSTRACT
We synthesized a series of CoFe Prussian blue analogues along which we tuned the amount of cesium cations inserted in the tetrahedral sites of the structure. Structure and electronic structure have been investigated, combining XANES, infrared spectroscopy, powder X-ray diffraction experiments, and magnetization measurements. The change of the magnetization induced by light along the series shows that the efficiency of the photoinduced magnetization, evidenced a few years ago in similar compounds by Hashimoto et al. (Sato, O.; Iyoda, T.; Fujishima, A.; Hashimoto, K. Science 1996, 272, 704-705; Sato, O.; Einaga, Y.; Iyoda, T.; Fujishima, A.; Hashimoto, K. J. Electrochem. Soc. 1997, 144, L11-L13; Sato, O.; Einaga, Y.; Iyoda, T.; Fujishima, A.; Hashimoto, K. J. Phys. Chem. B 1997, 101, 3903-3905; Einaga, Y.; Ohkoshi, S.-I.; Sato, O.; Fujishima, A.; Hashimoto, K. Chem. Lett. 1998, 585-586; and Sato, O.; Einaga, Y.; Fujishima, A.; Hashimoto, K. Inorg. Chem. 1999, 38, 4405-4412), depends on a compromise between the number of excitable diamagnetic pairs and the amount of [Fe(CN)6] vacancies giving the network flexibility. Besides the efficiency of the photoinduced process, the amount of [Fe(CN)6] vacancies also controls a thermally induced electron transfer.