RESUMO
Renal transplantation remains the best treatment option of renal replacement for end-stagechronic kidney disease. Surgical advances in graft quality and implantation techniques have improved transplantation during the last two decades. This has reduced both urologic and vascular complications after implantation. A detailed understanding of renal graft and transplantation anatomy is important to reduce transplantation morbidity. The aim of this article is to provide a detailed anatomic description of the kidney and regions usually involved in human renal transplantation (iliac fossa and left lumbar fossa), to provide basic instructions for thenovice transplant surgeon, and to improve the anatomic knowledge of the experienced transplant surgeon.
El trasplante renal continua representando la mejor de las opciones de tratamiento sustitutivo para la enfermedad renal crónica terminal. Desde un punto de vista quirúrgico los avances producidos en la últimas dos décadas descansan sobre las potenciales mejoras en la calidad del injerto y las técnicas de implante. Éstas últimas se han centrado fundamentalmente en la disminución de las complicaciones, tanto urológicas como vasculares, que pueden aparecer tras el mismo. Un conocimiento preciso de la anatomía del injerto renal y de las regiones implicadas en el trasplante resulta de crucial importancia de cara a disminuir la morbilidad. El objetivo de éste trabajo es realizar una descripción detallada de la anatomía renal y de las regiones anatómicas habitualmente involucradas en el trasplante renal del humano (fosa iliaca y fosa lumbar izquierda), para facilitar el aprendizaje del cirujano de trasplante novel y mejorar el grado de conocimiento anatómico del cirujano de trasplante experimentado.
Assuntos
Falência Renal Crônica , Transplante de Rim , Aloenxertos , Humanos , RimRESUMO
The infusion and persistence in a transplant recipient of donor-derived bone marrow cells (DBMC) of multi-lineage can lead to a state of permanent chimerism. In solid vascular organ transplantation, the donor bone marrow lineage cells can even be derived from the transplant organ, and these cells can be detected in very small numbers in the recipient. This has been called microchimerism. Much controversy has developed with respect to the function of chimeric cells in organ transplantation. One idea is that the occurrence of these donor cells found in microchimerism in the recipient are coincidental and have no long-term beneficial effect on engraftment. A second and opposing view, is that these donor cells have immunoregulatory function that affect both the acute and chronic phases of the recipient anti-donor responses. It follows that detecting quantitative changes in chimerism might serve as an indication of the donor-specific alloimmune or regulatory response that could occur in concert with or independent of other adaptive immune responses. The latter, including autoimmune native disease, need to be controlled in the transplant organ. The safety and immune tolerance potential of DBMC infusion with deceased and living donor renal transplants was evaluated in a non-randomized trial at this center and compared with non-infused controls given identical immunosuppression. Overall DBMC infusions were well tolerated by the recipients. There were no complications from the infusion (s), no episodes of graft-vs-host disease (GVHD) and no increase infections or other complications. In the deceased DBMC- kidney trial, actuarial graft survival at 5 years was superior especially when graft survival was censored for recipient death. Acute rejections were significant reduced in patients given two DBMC infusions, and chronic rejection was dramatically reduced in all DBMC treated patients. The most interesting finding was that the degree of microchimerism slowly increased over the years the DBMC group that had exhibited no rejection episodes. In the DBMC-living related trial, the incidence of acute rejection did not differ between groups. However, DBMC chimerism in recipient iliac crest marrow had increased more rapidly than might be predicted from results previously seen in the cadaver group, despite four times fewer DBMC infused, with the generation of T- regulartory cells in-vitro assays.