Nanoparticles transfected with plasmid-encoded lncRNA-OIP5-AS1 inhibit renal ischemia-reperfusion injury in mice via the miR-410-3p/Nrf2 axis.

Nanostructures composed of liposomes and polydopamine (PDA) have demonstrated efficacy as carriers for delivering plasmids, effectively alleviating renal cell carcinoma. However, their role in acute kidney injury (AKI) remains unclear. This study aimed to investigate the effects of the plasmid-encoded lncRNA-OIP5-AS1@PDA nanoparticles (POP-NPs) on renal ischemia/reperfusion (RI/R) injury and explore the underlying mechanisms. RI/R or OGD/R models were established in mice and HK-2 cells, respectively. In vivo, vector or POP-NPs were administered (10 nmol, IV) 48 h after RI/R treatment. In the RI/R mouse model, the OIP5-AS1 and Nrf2/HO-1 expressions were down-regulated, while miR-410-3p expression was upregulated. POP-NPs treatment effectively reversed RI/R-induced renal tissue injury, restoring altered levels of blood urea nitrogen, creatinine, malondialdehyde, inflammatory factors (IL-8, IL-6, TNF-α), ROS, apoptosis, miR-410-3p, as well as the suppressed expression of SOD and Nrf2/HO-1 in the model mice. Similar results were obtained in cell models treated with POP-NPs. Additionally, miR-410-3p mimics could reverse the effects of POP-NPs on cellular models, partially counteracted by Nrf2 agonists. The binding relationship between OIP5-AS1 and miR-410-3p, alongside miR-410-3p and Nrf2, has been substantiated by dual-luciferase reporter and RNA pull-down assays. The study revealed that POP-NPs can attenuate RI/R-induced injury through miR-410-3p/Nrf2 axis. These findings lay the groundwork for future targeted therapeutic approaches utilizing nanoparticles for RI/R-induced AKI.

The functional activity of donor kidneys is negatively regulated by microribonucleic acid-451 in different perfusion methods to inhibit adenosine triphosphate metabolism and the proliferation of HK2 cells.

This study explored the regulation of different perfusion methods on ischemia-reperfusion injury in donor kidneys. In this study, renal cortical/medullary tissue specimens were collected from porcine kidneys donors using different perfusion methods at various time points. Hematoxylin and eosin (H&E) staining was used to test the histological differences. Differentially expressed micro-ribonucleic acids (miRNAs) were identified by miRNA transcriptome sequencing. Reverse transcription-polymerase chain reaction (RT-PCR) tests were used to verify the changes in miRNAs in the kidney tissue taken from different perfusion groups. The related signaling pathways and the changes in the cell functions of different perfusion groups were analyzed by Kyoto Encyclopedia of Genes and Genomes (KEGG) /Gene Ontology (GO) bioinformatics analyses. The effects of miRNA overexpression on the metabolism and proliferation of HK2 cells were detected by ATP kit and MTT assay. The H&E staining results showed that there were essentially no differences in the tissue samples among different perfusion groups at and before 12 h compared with a control group. The quantitative PCR results revealed that there was essentially no change in the expression of ssc-miR-451, ssc-miR-1285, and ssc-miR-486 in the cis infusion or joint infusion kidney groups, and their expression was significantly down-regulated over time in the trans-infusion kidney group. The bioinformatics analysis showed that the cellular component, molecular function, and biological processes of the kidney tissue, which had been perfused using three methods, had been consistently affected. The most significant changes after perfusion occurred in the intracellular metabolism signaling pathways. Furthermore, the energy metabolism and proliferation of the HK2 cells were significantly inhibited after the overexpression of miR-451. Specific miRNA markers, such as miR-451, may play a negative regulatory role in cell metabolism following the perfusion of kidney transplants using different methods.

A Clinical Study of Minilaparoscopy in the Treatment of Cryptorchidism with an Ipsilateral Inguinal Hernia.

Introduction: The aim of this study was to investigate the safety and efficacy of performing minilaparoscopy compared with standard laparoscopy in the treatment of cryptorchidism with an ipsilateral inguinal hernia. Materials and Methods: In total, 46 patients with cryptorchidism and an ipsilateral inguinal hernia were admitted to the Urology and Hernia and Abdominal Wall Surgery Departments of Beijing Chaoyang Hospital between October 2009 and July 2019. They were assigned to two groups: Group M and Group S. In Group M, 24 patients underwent herniorrhaphy and orchiopexy using minilaparoscopy, and in Group S, 22 patients underwent herniorrhaphy and orchiopexy using standard laparoscopy. Surgeons chose the procedure at random, and the patients were blinded to the selected procedure. Results: Postoperative painkiller demand (P = .043) and first postoperative day Numerical Rating Scale scores (P = .032) were lower in Group M than Group S, and the average hospital stay was shorter (P = .041) in Group M. Furthermore, 21 of the 24 procedures in Group M were successful, 3 procedures of Group M were converted from mini- to standard laparoscopy, and all 22 procedures in Group S were successful. The Observer Scar Assessment Scale questionnaire results of Group M were significantly higher than for patients in Group S (P = .038). Conclusion: Our findings suggest that treatment of cryptorchidism with ipsilateral inguinal hernia using minilaparoscopy is as safe and effective as standard laparoscopy.

A controlled clinical study of a two-trocar mini-laparoscopic technique versus the standard laparoscopic technique in treatment of adult renal cysts.

INTRODUCTION: Laparoscopic renal cyst decortication is currently the best choice for the treatment of simple renal cysts and is widely used in clinical practice. AIM: To investigate the safety and clinical efficacy of two-trocar mini-laparoscopic decortication of adult renal cysts. MATERIAL AND METHODS: A total of 90 patients were enrolled in the study and randomly divided into two groups: a two-trocar mini-laparoscopic treatment group (M group) and a three-trocar standard laparoscopic treatment group (S group), with 45 patients in each group. RESULTS: The average length of hospital stay was shorter, and the demand for postoperative analgesics was less in the M group than in the S group (p < 0.05). The proportion of "very satisfied" patients in the patient physical recovery satisfaction survey was significantly higher in the M group than in the S group (p < 0.05). Of the 45 patients in the M group, 40 successfully underwent surgery. In 3 patients, the two-trocar procedure was converted to a three-trocar procedure due to difficulty in separating perirenal adhesion for visualization. Mini-laparoscopic surgery was converted to classic laparoscopic surgery in 2 patients. In the S group, 44 patients successfully underwent the renal cyst decortication procedure. One patient underwent partial renal resection due to an intraoperative diagnosis of multilocular cystic renal cell carcinoma. Postoperative urine leakage was reported in 3 patients in the M group and two in the S group. CONCLUSIONS: Two-trocar mini-laparoscopic treatment of renal cysts is as safe and effective as traditional laparoscopy but is associated with less cosmetic damage, leading to a better physical appearance.

Laparoscopic Orthotopic Kidney Transplantation in Swine: A Novel Vascular Prop Device for Venous Anastomoses.

Objective: To investigate the safety and efficacy of a vascular prop device for laparoscopic orthotopic kidney transplantation (LOKT) in swine. Material and Methods: Twenty swine were randomly divided into two groups. A vascular prop device was used in the observation (VP) group, and the vein beltization technique was used in the control (VB) group. The right kidney, as a donor graft, was laparoscopically transplanted to the location of the left kidney after a left nephrectomy. Data on the operative time, venous anastomotic time, vein stenosis, etc., and the survival of the swine in the two groups were recorded. Results: The mean transplant operative time, the mean cold ischemia time, and the venous anastomotic times in the VP group were significantly shorter than those in the VB group. Seven swine in the VP group and three swine in the VB group survived for 7 days. Autopsy results showed the occurrence of one artery stenosis and one vein stenosis in the VP group and one artery stenosis and five vein stenoses in the VB group. The median survival time was 6.25 days for the swine in the VP group and 4.40 days for those in the VB group. Conclusions: The vascular prop device is safe and feasible for LOKT in swine and may accelerate venous anastomosis and ensure the quality of venous anastomotic stoma.

Effect of individualized psychological intervention on negative emotion and sleep quality of patients after bladder cancer surgery: a randomized controlled trial.

BACKGROUND: Bladder surgery has a negative impact on patients' mental health, sleep quality. Conventional nursing interventions failed to meet the clinical needs. Therefore, this parallel-group RCT was performed to assess the effect of individualized psychological intervention on patients' negative emotions and sleep quality after bladder cancer surgery. METHODS: Patients with bladder cancer admitted to our hospital (from September 2018 to October 2020) and underwent surgical treatment were selected as the research objects. They were randomly allocated to a parallel control group or observation group based on a computer-generated random numbers table. Because our study included behavioral intervention, blinding was not possible for participants and care givers. The control group received conventional nursing care, and the observation group received strengthened individualized psychological intervention under the nursing measures of the control group. Sleep quality, anxiety, depression, nursing compliance, and the occurrence of bladder spasm were compared between the two groups. RESULTS: Seventy-eight eligible patients were included and randomly divided in two groups (n=39 for each group). The intervention procedure was completed without losses and exclusions of patients after randomization. Before the intervention, the Pittsburgh Sleep Quality Index Scale and the anxiety and depression scores were comparable between the two groups (P>0.05). After the intervention, the data of the two groups were significantly improved. The sleep quality, sleep time, sleep efficiency, the time to fall asleep, hypnotic drugs, sleep disorders, daytime dysfunction, anxiety score, and depression score of the observation group were lower than those of the control group, with significant differences (P<0.05). The total nursing compliance rate of the observation group reached 100.00%, which was higher than the control group. The difference between the groups was significant (P<0.05). There was no significant difference in the incidence of bladder spasm between the two groups (P>0.05). CONCLUSIONS: Individualized psychological intervention applied to bladder cancer surgery can effectively improve patients' negative emotions and improve their sleep quality. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100046468.

A controllable double-cycle cryogenic device inducing hypothermia for laparoscopic orthotopic kidney transplantation in swine.

BACKGROUND: It is necessity to maintain donor kidneys at a low temperature for laparoscopic orthotopic kidney transplantation (LOKT). We recently designed a controllable double-cycle cryogenic device (DCD) with a safer and more effective cooling setting. This study aimed to evaluate the safety and efficacy of this device in a swine model. METHODS: A total of 20 pigs were procured for this study. We performed LOKT on 8 pigs using the controllable DCD for hypothermia, on another 8 pigs using the silicon tube cage (STC) for hypothermia, and on 4 pigs as the control group with no hypothermia measures (NH). The LOKTs were performed in autotransplantation mode in which the right kidney vein and artery were end-to-end anastomosed to the left kidney vein and artery in all three groups. The perioperative data, graft temperatures, and surgical complications were recorded, and histological examinations of kidney specimens were performed. RESULTS: The average surface temperature in the DCD group (5±3.5 °C) was significantly lower than that in the STC (10±5.5 °C) and NH (28±3.0 °C) groups. In the DCD and STC groups, the temperature between the cooling setting and the adjacent peritoneum was 30±3.0 and 12±5.0 °C, respectively. All pigs survived for 7 days in the DCD group. In the STC group, 2 pigs died from liver lesions and other causes. A single pig had diabetes insipidus. No pigs survived for 7 days in the NH group. The specimens from pigs immediately after revascularization and from the surviving pigs on day 7 following transplantation showed that the morphology of the glomerular and renal tubules was largely normal in the DCD and STC groups. However, in the NH group, there was minimal interstitial and tubular oedema, and endothelial cell swelling occurred in some specimens immediately after revascularization. Pathological examination of the harvested graft specimens showed severe acute tubular necrosis in the NH group. CONCLUSIONS: The newly designed controllable DCD can achieve the goal of cooling the kidney and warming the patient and may be a reliable, effective, inexpensive, and practical hypothermic maintenance system for LOKT in swine.

Clinical Observation of UreTron Single-Probe Ultrasonic Intracorporeal Lithotripter for Ureteral Calculi.

OBJECTIVE: The present study aimed to observe and discuss the effectiveness and safety of the UreTron single-probe ultrasonic intracorporeal lithotripter in ureteroscopic lithotripsy. METHODS: The clinical data of patients with unilateral solitary ureteral calculi treated with ureteroscopic lithotripsy who were hospitalized at the Department of Urology (West District) of Beijing Chaoyang Hospital between March 2016 and August 2020 were selected for retrospective analysis. The patients were divided into the UreTron group (group U) and holmium laser group (group H) according to the lithotripsy method adopted. The operation duration, length of hospital stay, stone clearance rate, proportion of patients requiring flexible ureteroscopy-assisted lithotripsy, and complications were compared between the groups. RESULTS: There was no statistical difference between the groups in terms of the general characteristics, operation duration, or length of hospital stay (P > 0.05). Regarding the stone clearance rate (group U=93.5%; group H=75%), proportion of patients requiring flexible ureteroscopy-assisted lithotripsy (group U=6.5%; group H=27.8%), and incidence of surgical complications (group U=1 case; group H=9 cases), group U was superior to group H, and the differences between the groups were statistically significant (P < 0.05). However, the differences in other complications (cardiocerebral complications and lower extremity thrombosis) were not statistically significant between the groups (P > 0.05). CONCLUSION: The UreTron system is a new lithotripsy apparatus that is safe and effective for ureteroscopic lithotripsy and has certain advantages in terms of the stone clearance rate, proportion of patients requiring flexible ureteroscopy-assisted lithotripsy, and surgical complications, making it worthy of clinical application.

Lactobacillus acidophilus ATCC 4356 Alleviates Renal Ischemia-Reperfusion Injury Through Antioxidant Stress and Anti-inflammatory Responses and Improves Intestinal Microbial Distribution.

Background: Ischemia-reperfusion injury (IRI) is one of the main causes of acute kidney injury. Our previous results have shown that anti-oxidative stress decreased in the renal IRI model. This study aimed to investigate the effect of Lactobacillus acidophilus ATCC 4356 on oxidative stress, inflammation, and intestinal flora in renal IRI. Methods: The model of renal IRI was established by cross-clamping the renal pedicle with non-traumatic vascular forceps. H&E staining was applied to observe the damage of kidney tissue in each group. The concentrations of serum blood urea nitrogen (BUN), creatinine (Cre), superoxide dismutase (SOD), glutathione (GSH), and malondialdehyde (MDA) were detected by biochemical kit. ELISA measured the concentrations of interleukin (IL)-1ß, IL-8, IL-4, and IL-10. qRT-PCR was performed to detect molecular expressions of ATCC 4356, oxidative stress-related factors [nuclear factor-related factor 2 (Nrf2), heme oxygenase 1 (HO-1)], inflammatory factors [tumor necrosis factor (TNF)-α, IL-1ß, IL-8, interferon (IFN)-γ, IL-4, IL-10], and apoptosis-related factors [caspase 3, Bax, Bcl2, high-mobility group box protein 1 (HMGB1)]. Except for ATCC 4356, the protein expression of the above indicators was detected by Western blot. The apoptosis level of renal tissue cells was detected by TdT-mediated dUTP nick end labeling (TUNEL). 16S rDNA gene sequencing was used to detect the changes of microbial species in the contents of the duodenum and screen out the differentially expressed flora. Results: Both the glomeruli and renal tubules of ischemia/reperfusion (I/R) mice were severely damaged. H&E result displayed that L. acidophilus ATCC 4356 attenuated the infiltration of inflammatory cells caused by I/R. ATCC 4356 reduced the high expression of BUN and Cre in I/R mice with a dose effect. It also reduced the high expression of MDA, TNF-α, IL-1ß, IL-8, IFN-γ, caspase 3, Bax, and HMGB1 in I/R mice, while it increased the low expression of SOD, GSH, Nrf2, HO-1, IL-4, IL-10, and Bcl2 in I/R mice. ATCC 4356 inhibited the high level of apoptosis in the kidney tissue of I/R mice. In IRI mice, the top 3 different gut microbiota were Helicobacter, cultivated_bacterium, and k__Bacteria_ASV_3 compared with sham mice. Oral L. acidophilus ATCC 4356 reversed this change. Conclusion: L. acidophilus ATCC 4356 attenuated renal IRI through anti-oxidative stress and anti-inflammatory response and improved the intestinal microbial distribution.

Extraperitoneal Laparoscopic Kidney Transplantation: Preliminary Clinical Experiences from China.

OBJECTIVE: To report on the pioneering clinical experiences of six cases of extraperitoneal laparoscopic kidney transplantation in China. METHODS: For the first time in clinical practice, a customised, controllable double-circulation cooling device was used to protect the transplanted kidney. Of the six patients, two underwent an allograft renal transplantation because they had been diagnosed with uraemia and were on maintenance haemodialysis. The other four patients underwent kidney autotransplantation because of a central renal tumour. RESULTS: The extraperitoneal laparoscopic kidney transplantations were successfully completed between 2017 and 2018. The operative time for the two patients undergoing the allograft transplantation was 3-3.5 h. The time for venous anastomosis was approximately 53-65 min, and the time for arterial anastomosis was approximately 25-30 min. The creatinine level was 90-80 µmol/L after surgery. The operative time of the four patients who underwent autotransplantation was 9.4-17.5 h. The times of venous and arterial anastomosis were 58-90 min and 35-48 min, respectively. The follow-up B-mode ultrasound after surgery showed good blood supply in the spared nephron. A renal graft was removed from one patient 6 months after surgery because of renal atrophy and dysfunction caused by poor blood supply. Five patients (two undergoing allografting and three undergoing autografting) completed the 12-month follow-up, and their renal graft function was good. CONCLUSIONS: Extraperitoneal laparoscopic kidney transplantation, either allograft or autologous transplantation, is a safe and feasible procedure with a good chance of survival for the transplanted kidney. A customised cooling device is effective and practical during laparoscopic kidney transplantation.

A comparative study of mini- versus standard laparoscopy in the treatment of renal cysts.

INTRODUCTION: This study aimed to investigate the safety and efficacy of mini-laparoscopy for renal cyst unroofing. MATERIAL AND METHODS: Eighty-six patients for treatment of renal cysts that met the selection criteria were included in this study. They were divided into two groups. Forty-five patients underwent cyst unroofing via mini-laparoscopy (Group M), and 43 patients underwent cyst unroofing via standard laparoscopy (Group S). There were no differences between the two groups in terms of sex, age, body mass index or clinical data. Data from the groups were recorded and analyzed. RESULTS: The average hospital stays were shorter (p = .039) and postoperative painkiller demand was lower (p = .031) in Group M than in Group S. Forty-one out of 45 procedures in Group M were successful, and all 43 cases in Group S were successfully. With a follow-up period of 0.5 to 5.5 years, there was no significant difference in recovery rate (p = .213). Questionnaires showed that patients in Group M were significantly more satisfied with their cosmetic results than were patients in Group S (p = .041). CONCLUSION: Our findings suggest that renal cyst decortications with mini-laparoscopic instruments are as safe and effective as procedures using standard laparoscopic instruments. Cosmetically, the results are better with mini-laparoscopy than with standard laparoscopic unroofing.

An Effective Cooling Device for Minimal-Incision Kidney Transplantation.

BACKGROUND This study investigated the safety and efficacy of a new cooling device for use in minimal-incision kidney transplantation (MIKT). MATERIAL AND METHODS From June 2016 to December 2021, 9 patients underwent MIKT surgery in our hospitals using the new cooling device to maintain hypothermia. We recorded and analyzed information on the etiology, comorbid status, ongoing renal replacement assessment, BMI, HLA mismatching sites of donors and recipients, and perioperative and postoperative clinical data for recipients. RESULTS Kidney transplantation was successfully performed in all patients. The kidney surface temperature measurement results showed that the intraoperative renal anterior and posterior surface temperatures were stable at approximately 3.8±1.2°C and 5.2±1.3°C, respectively, during ice-water circulation. The mean operation time was 112±15 min, the artery anastomosis time was 16±6.0 min, and the vein anastomosis time was 14±4.5 min. All recipients recovered uneventfully. The patients were followed up for 6-30 months. Urinary and vascular complications were not found in any recipients. CONCLUSIONS The new cooling device can facilitate MIKT. It is safe and feasible to carry out MIKT using the new cooling device, which can reduce surgical trauma and improve the quality of vascular anastomosis with satisfactory cosmetic results.

FAM83H-AS1 is associated with clinical progression and modulates cell proliferation, migration, and invasion in bladder cancer.

FAM83H-AS1, also known as oncogenic long noncoding RNA (lncRNA)-3, is a novel lncRNA that has been suggested to be dysregulated in a variety of human cancers. However, the expression status and function of FAM83H-AS1 in bladder cancer are still unknown. The object of our study is to explore the clinical value of FAM83H-AS1 in patients with bladder cancer and the biological function of FAM83H-AS1 in bladder cancer cells. In our results, the expression of FAM83H-AS1 was obviously elevated in bladder cancer tissue samples and bladder cancer cell lines compared with adjacent normal tissue samples and normal bladder epithelial cell lines, respectively. In addition, high expression of FAM83H-AS1 was associated with advanced clinical stage and the presence of muscularis invasion and served as an independent poor prognostic factor for overall survival in patients with bladder cancer. The loss-of-function study showed that silencing FAM83H-AS1 expression suppressed cell proliferation, migration, and invasion and induced cycle arrest at G0/G1 phase. In conclusion, FAM83H-AS1 is involved in the progression of bladder cancer and serves as a prognostic biomarker and potential therapeutic target for patients with bladder cancer.

Feasibility of Laparoscopic Combined Para-Orthotopic Pancreas and Orthotopic Kidney Transplantation: Initial Research with a Pig Model.

BACKGROUND The aim of this study was to investigate the feasibility of laparoscopic combined para-orthotopic pancreas and orthotopic kidney transplantation in a pig model. MATERIAL AND METHODS Twelve white female pigs, (4-5 months old, weight range 40-45 kg) were used as donors and recipients, and 6 laparoscopic-combined pancreas and kidney transplantations were performed. After bilateral nephrectomy, the pancreatic artery and vein were anastomosed to the right renal artery and vein, respectively, and the pancreatic fluid was diverted to the duodenum or jejunum. The renal artery and vein were anastomosed to the left renal artery and vein, respectively. The ureter (or kidney pelvis) was anastomosed to the left native ureter (or kidney pelvis). The data of the operations were recorded, and grafts were inspected at autopsy. RESULTS Four of the 6 recipient pigs underwent the entire procedure. The duodenum-to-duodenum anastomosis was unfinished in 1 case, and both the duodenum-to-duodenum and renal pelvis-to-pelvis anastomoses were left unperformed in another case. The mean recipient operative time was 429±43 minutes. The mean venous and arterial anastomotic times were 69±15 minutes and 37±18 minutes, respectively, for pancreas transplantation and 56±09 minutes and 42±06 minutes, respectively, for kidney transplantation. The time for renal pelvis-to-pelvis anastomosis was 56±13 minutes and for duodenum-to-duodenum anastomosis was 90±13 minutes. The mean blood loss for recipient pigs was 98±35 mL. An immediate viable blood supply was seen in the 4 pancreatic grafts and in the 5 kidney grafts during the operation by the appearance of a bright red color after revascularization. Five pancreatic grafts had autopsy-proven reliable artery anastomoses and 4 reliable vein anastomoses. All 6 kidney grafts had autopsy-proven reliable artery anastomoses; however, 1 had a vein anastomotic stricture. CONCLUSIONS Our study showed that laparoscopic-combined para-orthotopic pancreas and orthotopic kidney transplantation in pigs is surgically possible.

A comparative study on the efficacy of a retrograde perfusion technique and an antegrade perfusion technique for donor kidney recovery in transplantation in pigs.

BACKGROUND: Donor organ shortage is a significant problem in kidney transplantation. Improvement of perfusion techniques can increase the number of available organs. The aim of this study is to investigate the efficiency and safety of retrograde perfusion (RP) of kidney grafts during organ recovery after transplantation in pigs. METHODS: Ten pigs were divided into two groups, six in the study group for the RP technique and four in the control group for standard antegrade perfusion (AP). The left kidney was removed and perfused by the RP or AP method according to the study group. The perfused left kidney was auto-transplanted to the right groin location. The right kidney was removed and perfused in the same manner and then stored at 4 °C for 24 h prior to histopathological analysis. Data in both groups were observed and recorded. RESULTS: All kidneys perfused by both the RP and AP methods were satisfactory in appearance. All grafts showed diuresis from the first postoperative day onward. On postoperative day 7, the mean serum creatinine (Scr) and blood urea nitrogen (BUN) levels were 174 ± 9.7 ìmol/L and 27.7 ± 2.5 mg/dL in the RP group, and they were 168 ± 13.7 ìmol/L and 26.5 ± 4.3 mg/dL, respectively, in the AP group (p = 0.483 for Scr and p = 0.646 for BUN). The mean peak Scr levels in the RP group (570 ìmol/L) and the AP group (530 ìmol/L) were similar. All pigs survived with adequate renal function throughout the study period. There was minimal interstitial and tubular edema, and there was endothelial cell swelling in some specimens before revascularization in both groups. At postoperative day 7, the auto-transplanted kidneys showed normal glomerular and tubular structure with little interstitial edema and inflammatory cell infiltration in the grafts. No differences were identified between the two groups. Under electron microscopy, the tubular epithelial cells, glomeruli, and glomerular capillary endothelium of the grafts appeared normal in both groups after 24 h in cold storage. CONCLUSIONS: Kidney grafts in pigs perfused by RP had normal function after transplantation compared with the AP control group. Therefore,retrograde perfusion is potentially an efficient, safe kidney perfusion method for organ recovery.

Short- and long-term outcomes of kidney transplants with kidneys lavaged by retrograde perfusion technique.

OBJECTIVE: To evaluate the clinical safety and efficacy of the retrograde perfusion technique in kidney transplantation. METHODS: Between January 2001 and June 2011, 24 cases of kidney transplantation with kidneys perfused using the retrograde perfusion technique due to renal artery variations or injury were selected as the observation group (retrograde perfussion group, RP group). Twenty-two cases of kidney transplantation via conventional perfusion were chosen as the control group (antegrade perfussion group, AP group). There were no statistically significant differences in donor data between the two groups. Cold ischemia time, warm ischemia time, renal perfusion time, amount of perfusion fluid, acute renal tubular necrosis, wound infection, urinary fistula, graft kidney function, and the 1-year, 3-year, and 5-year survival rates for the grafted kidney in both groups were observed and recorded. RESULTS: The kidney perfusion time was shorter in the RP group than that in the AP group (3.14 ± 1.00 vs. 5.02 ± 1.15 min, P = 0.030). There were 10 cases of acute renal tubule necrosis in the RP group and 5 in the AP group. The length of hospital stay was 40 ± 14 d in the RP group and 25 ± 12 d in the AP group. The follow-up time was 3.5-8.5 years (mean 6.25 years). The 1-, 3-, and 5-year survival rates for the grafted kidney were 95.8%, 75.5%, and 65.5% in the RP group and 97.1%, 82.5%, and 68.4% in the AP group, respectively (P>0.05). CONCLUSIONS: This study indicates that retrograde perfusion is safe and practicable for cadaveric kidney harvesting and can be regarded as a better alternative or remedial measure for a poorly perfused kidney due to vascular deformity or injury.

Feasibility of laparoscopic orthotopic kidney transplantation: initial research with a pig model.

BACKGROUND: The objective of this study was to investigate the feasibility of laparoscopic orthotopic kidney transplantation. MATERIAL AND METHODS: This study involved bilateral laparoscopic nephrectomy in pigs. One of 2 kidneys harvested from the first or second nephrectomy was chosen as the donor kidney to be transplanted to the left or right side in the second nephrectomy position. Eight laparoscopic orthotopic kidney transplantations were performed. RESULTS: The mean venous anastomotic time was 70 minutes (45-108 minutes). The mean arterial anastomotic time was 31 minutes (23-45 minutes). Three pigs received life-supporting auto-renal allografts. Their serum creatinine levels were 163, 285, and 440 µmol/L (baseline: 133 µmol/L), respectively, at postoperative day 7. One died of a possible anesthetic overdose immediately after the operation. Four pigs died at postoperative days 2, 3, 4, and 4. Of 8 completed laparoscopic orthotopic kidney transplantations, 6 had autopsy-proven reliable artery and vein anastomoses. Histopathologic examination of the autografts demonstrated normal renal architecture in 1 survival, and acute tubular necrosis in the remaining 7 (stenosis in one and arterial thrombus in another). CONCLUSIONS: Our study reinforces the feasibility of laparoscopic orthotopic kidney transplantation in pigs. This study comprised only initial practices; further practice is needed to refine the surgical procedures and decrease surgical complications in laparoscopic orthotopic kidney transplantation.

Comparison of 2 devices in pigs to induce hypothermia in laparoscopic orthotopic kidney transplant.

OBJECTIVES: To laparoscopically compare the effectiveness of 2 cooling devices for renal hypothermia and investigate the feasibility of laparoscopic orthotopic kidney transplant using a pig model. MATERIALS AND METHODS: Eight pigs were divided into 2 groups of 4 animals each. Laparoscopic nephrectomy and autotransplant were performed first on only the right kidney. One week later, these procedures were performed on the left kidney, while the first transplanted autograft was removed. After 1 more week, the left autograft was removed for observation. In 1 group, the silicon tube cage was used to induce hypothermia during laparoscopic orthotopic kidney transplant (silicon tube cage group), and in the other group, the plastic bag jacket was used to induce hypothermia during laparoscopic orthotopic kidney transplant (plastic bag jacket group). RESULTS: Two pigs in the silicon tube cage group survived for 7 days after the second autotransplant with serum creatinine levels of 210 µmol/L and 1010 µmol/L. One pig in the plastic bag jacket group survived for 5 days. The mean surface temperature of the grafts was maintained at 9°C ± 3°C and 12°C ± 3°C in the silicon tube cage and plastic bag jacket groups (P = .166). Three of 6 plastic bag jacket devices were ruptured by stitches or instruments. The mean venous and arterial anastomotic times in the silicon tube cage group were significantly shorter than were those in the plastic bag jacket group. CONCLUSIONS: Our study shows that the silicon tube cage may be a reliable renal cooling device for use in laparoscopic kidney transplant and indicates the feasibility of laparoscopic orthotopic kidney transplant in pigs.

A novel technique for suture-free repair of renal allograft rupture.

BACKGROUND: Renal allograft rupture (RAR) is a rare complication, but it can cause graft loss and be life-threatening. Surgical exploration and repair is essential for saving the kidney graft. The aim of this article is to describe a novel suture-free technique for management of RAR. MATERIAL/METHODS: Twenty-six RARs were diagnosed in 1851 kidney transplants from November 2002 to November 2008. The study was divided into 2 groups: a suture group and a suture-free group. Twelve cases were treated in the suture group, whereas 14 were treated by the suture-free technique. In the suture-free group, absorbable thread was used to bundle the ruptured renal graft. For the suture group, autologous cubic muscular tissues or external oblique aponeurosis were used as pledgets. RESULTS: In the suture-free group all 14 grafts were rescued with creatinine (Cr) at 1.8 ± 0.62 mg/dl on discharge. In the suture group all 12 grafts were repaired successfully with Cr 1.9 ± 0.63 mg/dl on discharge. The 1-, 3- and 5-year graft survival rate was 92.8%, 82.5%, 70.50%, respectively, in the suture-free group and 84.1%, 75.5%, 67.4%, respectively, in the suture group. The suture-free technique had shorter operation time, less blood transfusion and shorter hospital stay. CONCLUSIONS: The suture-free technique is a safe and effective technique for treatment of RAR, with advantages of shorter operating time, less blood loss and quicker recovery after surgery.