Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management.

The objective of this review is to explore the available literature on solid renal masses (SRMs) in transplant allograft kidneys to better understand the epidemiology and management of these tumors. A literature review using PubMed was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Fifty-six relevant studies were identified from 1988 to 2015. A total of 174 SRMs in 163 patients were identified, with a mean tumor size of 2.75 cm (range 0.5-9.0 cm). Tumor histology was available for 164 (94.3%) tumors: clear cell renal cell carcinoma (RCC; 45.7%), papillary RCC (42.1%), chromophobe RCC (3%), and others (9.1%). Tumors were managed by partial nephrectomy (67.5%), radical nephrectomy (19.4%), percutaneous radiofrequency ablation (10.4%), and percutaneous cryoablation (2.4%). Of the 131 patients (80.3%) who underwent nephron-sparing interventions, 10 (7.6%) returned to dialysis and eight (6.1%) developed tumor recurrence over a mean follow-up of 2.85 years. Of the 110 patients (67.5%) who underwent partial nephrectomy, 3.6% developed a local recurrence during a mean follow-up of 3.12 years. The current management of SRMs in allograft kidneys mirrors management in the nontransplant population, with notable findings including an increased rate of papillary RCC and similar recurrence rates after partial nephrectomy in the transplant population despite complex surgical anatomy.

Successful combined hepatic and pancreatic allograft retrieval in donors with a replaced right hepatic artery.

The parallel development of reconstructive techniques used to retrieve and transplant organs with vascular anomalies, and of techniques used in the multiple organ retrieval process, have facilitated the recovery of the maximal number of transplantable organs from a limited supply of donors. Recent contributions to this effort are descriptions of combined retrieval of both liver and whole organ pancreaticoduodenal allografts from the same multiple organ donor. Suggested contraindications for the retrieval of the latter allograft have included the presence of a replaced right hepatic artery originating from the superior mesenteric artery. We describe herein the techniques used in retrieving both the liver and the whole pancreas from donors with this vascular anomaly.

Major abdominal complications following cardiac transplantation. Utah Transplantation Affiliated Hospitals Cardiac Transplant Program.

Serious complications involving the alimentary tract are commonly reported following cardiac transplantation, and may be associated with significant morbidity and mortality. The aim of this report was to review the incidence, severity, and outcome of abdominal complications in our heart transplant population in whom we used corticosteroid-sparing protocols for immunosuppression. From March 1985 through September 1988, 178 patients underwent 185 cardiac transplants. Twenty-six cardiac transplant recipients (15%) sustained 33 major abdominal complications, including gastrointestinal bleeding (n = 8), pancreatitis (n = 8), bowel perforation (n = 6), cholecystitis (n = 4), and miscellaneous other problems (n = 7). Operative therapy was required in 61% of cases. No deaths were caused by the gastrointestinal complications of their operative management. Corticosteroid-sparing immunosuppression may be responsible for the low incidence of abdominal morbidity, and early, aggressive surgical intervention may reduce subsequent mortality.

Function of pancreas allografts more than 1 year following transplantation.

At the University of Iowa, Iowa City, 75 pancreas transplant procedures were performed for type I diabetes mellitus from March 1984 to September 1988. Forty-seven of these transplants were performed simultaneously with kidney transplants from the same donor; 23 followed previous kidney transplants, and 5 were preuremic pancreas-only transplants. The 1-year patient survival rate is 85% and pancreas graft survival rate is 54%. The simultaneous kidney and pancrease group had a 1-year patient survival rate of 82%, a pancreas graft survival rate of 59%, and a renal graft survival rate of 73%. Thirty-one of 70 kidney and pancreas recipients had a functioning pancreas 1 year post transplantation and 26 of 31 currently have a functioning pancreas and are insulin free. Patient symptoms of neuropathy and gastroenteropathy are improved with long-term graft function. Some patients may develop type II diabetes post transplantation with impaired glucose tolerance despite high insulin production by the graft. Pancreas transplantation is the only therapy that achieves a euglycemic state as indicated by glycosylated hemoglobin and glucose tolerance testing. Centers must continue to follow up patients on a long-term basis to determine the final effects on the secondary complications of diabetes.

Trend analysis of the % VO2 max-HR regression.

The purpose of the study was to mathematically model the regression of percent of maximal oxygen consumption (% VO2 max) on relative (% of max) heart rate (HR). The 26 subjects (Ss) were classified based on activity levels into high, medium, and low-fitness. Each S performed a series of treadmill walks and runs ranging from 30 to 100% of max VO2. Percent of VO2 max and relative HR were determined during each exercise bout. The data were subjected to a trend analysis utilizing multiple regression techniques. The associated Rs were: linear 0.966, quadratic 0.971, cubic 0.971, and quartic 0.977. The second and fourth order terms statistically accounted for more of the variability than their predecessors, but these differences were not of practical significance. There were no statistically significant differences among the fitness subgroup regression slopes or intercepts for any of the sets of regression equations. The bivariate equation was Y = 1.369-X-40.99 (Y = % VO2 max and X=relative HR) with a standard error of the estimate of 5.67 % VO2 max.

Maximal steady state versus state of conditioning.

Criteria for the identification of maximal steady state as related to state of conditioning were evaluated. 13 volunteers walker and/or ran during a series of 15 min tests on a treadmill. The speeds ranged from mild to exhaustive. Heart rate was monitored continuously; VO2 was determined from 6 min to 9 min; and venous blood was obtained at 10 min and 15 min for lactate analyses. Max VO2 was established for each subject. Subjects were classified on level of conditioning according to the quantity and quality of their activity record for the previous 6 months. The 10 min heart rate associated with a blood lactate level of 2.2 mM/L (MSSHR) was the best predictor of conditioning. The relative VO2 (% of max VO2) found with a 10 min blood lactate concentration of 2.2 mM/L (RMSSVO2) was almost as accurate as MSSHR in predicting state of conditioning. Changes in blood lactate levels between 10 min and 15 min were not significantly related to conditioning.