Trasplante renal en bloque de donantes pediátricos en receptores adultos: un reto quirúrgico / Pediatric en bloc kidney transplantation to adult recipients: a surgical challenge

Introducción: Aportar y analizar los resultados de nuestra experiencia quirúrgica en 19 casos de trasplante renal en adulto utilizando injertos en bloque de donantes pediátricos. Material y método: Entre noviembre de 1996 y agosto de 2011 se han realizado en nuestro servicio 647 trasplantes renales en adultos, utilizando en 19 ocasiones (2,9%) injertos en bloque de donantes pediátricos. La media de edad de los donantes fue de 17,6 meses (intervalo: 5 días-48 meses). La media de edad de los receptores fue de 41,3 años (intervalo: 19-59 años). El peso medio de los donantes fue de 10,6 kg (intervalo: 3,5-23 kg) y el de los receptores fue de 63,6 kg (intervalo: 43-93 kg). Se valoró la función renal (creatinina sérica y aclaramiento de creatinina) en el postoperatorio inmediato y durante el seguimiento, así como la incidencia de complicaciones vasculares y su resolución. Resultados: La mediana del seguimiento fue de 22 meses (media: 34,9 meses; intervalo: 1-141 meses), siendo funcionantes 17 de los 19 injertos con creatinina dentro de la normalidad en 13 de los casos. Hubo complicaciones vasculares en 5 casos (26,3%), de los que solo 2 precisaron trasplantectomía precoz y 3 se resolvieron mediante angioplastia simple con mejoría morfológica y de la función renal. Conclusiones: Los trasplantes renales en bloque pediátrico suponen una alternativa válida en el trasplante renal del adulto, pero presentan mayores tasas de complicaciones vasculares postimplante. Una selección correcta de los donantes, una técnica vascular depurada y un tratamiento intensivo mediante angioplastia simple permite resolverlas en la mayoría de los casos (AU)

Introduction: To evaluate the outcome of our surgical experience in 19 cadaveric kidneys from pediatric donors, transplanted en bloc into adults recipients. Material and method: From November 1996 to August 2011, we have performed 647 adult renal transplantations, using pediatric en bloc grafts in 19 cases (2.9%). The mean age of donors was 17.6 months (range: 5 days to 48 months). The mean age of recipients was 41.3 years (range: 19-59 years). The mean weight of donors was 10.6 kg (range: 3.5-23 kg) and the mean weight of recipients was 63.6 kg (range: 43-93 kg). We evaluated the renal function (serum creatinine and creatinine clearance) in the immediate postoperative period and during the follow-up, as well as the incidence of vascular complications and their resolution. Results: The median follow-up was 22 months (mean: 34.9 months; range: 1-141 months). At the end of follow-up, 17 of the 19 grafts were functioning, with creatinine at normal levels in 13 of them. There were vascular complications in five cases (26.3%), only two cases required early transplantectomy, and the other three cases were resolved by renal or aortic graft angioplasty with morphological and renal function improvement. Conclusions: Pediatric en bloc kidneys are a valid alternative in adult renal transplantation, but show higher rates of vascular complications. A correct selection of donors, a correct vascular technique, an intensive treatment through simple angioplasty enable them to be resolved in most of the cases (AU)

Células madre y medicina regenerativa en urología, 2ª parte: urotelio, vejiga, uretra y próstata / Stem cells and regenerative medicine in urology, part 2: urothelium, urinary bladder, urethra and prostate

Introducción: La investigación en terapia celular y medicina regenerativa, desarrollada en su mayor parte en torno al estudio de las células madre, está obteniendo resultados prometedores en todas las especialidades médicas. En urología están llevándose a cabo grandes avances en este campo, si bien existen ciertas dificultades, pues, por ejemplo, a fecha de hoy aún no ha sido posible la completa identificación y aislamiento de las células madre uroteliales ni prostáticas humanas, aunque muchos grupos se están acercando cada vez más a ello. Material y métodos: Realizamos una búsqueda electrónica mediante la base de datos Pubmed, tanto de artículos originales como de revisiones, utilizando los criterios de búsqueda stem cells urology, urothelial stem cells, bladder stem cells, prostate stem cells, urethra stem cells, cell therapy urology, tissue engeneering urology y regenerative medicine urology. Resultados: Hemos hecho una revisión de 30 trabajos publicados hasta noviembre de 2009, tratando con ello de hacer una recopilación lo más completa posible, para poder conocer un poco mejor los avances realizados en este campo, desde los inicios hasta nuestros días. Conclusión: Aunque existen aún importantes numerosas incógnitas, la mayor de ellas conseguir la identificación, aislamiento y cultivo de las células madre renales, uroteliales y prostáticas humanas, esto no debe impedir a los investigadores el poder trasladar los resultados obtenidos en el laboratorio a la clínica (AU)

Introduction: Investigation in cell therapy and regenerative medicine, mainly developed around stem cell research, is reaching promising results in every medical specialities. There are also being great advances in Urology, despite the difficulties researchers are facing, as complete identification and isolation of human urothelial and prostatic stem cells has not been possible yet, although many groups are close to achieve it. Material and methods: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: "stem cells urology", "urothelial stem cells", "bladder stem cells", "prostate stem cells", "urethra stem cells", "cell therapy urology", "tissue engeneering urology" y "regenerative medicine urology". Results: We reviewed 30 articles published up to November 2009, trying to summarize thoroughly the most relevant findings and the last advances in this fild, from the first steps to this day. Conclusion: Despite the great lack of knowledge existing, especially the need for achieving the identification of kidney, urothelium and prostate stem cells, this shouldn’t prevent researchers from translating the laboratory results to the clinical work (AU)

[Stem cells and regenerative medicine in urology, part 2: urothelium, urinary bladder, urethra and prostate]. / Células madre y medicina regenerativa en urología, 2.a parte: urotelio, vejiga, uretra y próstata.

INTRODUCTION: Investigation in cell therapy and regenerative medicine, mainly developed around stem cell research, is reaching promising results in every medical specialities. There are also being great advances in Urology, despite the difficulties researchers are facing, as complete identification and isolation of human urothelial and prostatic stem cells has not been possible yet, although many groups are close to achieve it. MATERIAL AND METHODS: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: "stem cells urology", "urothelial stem cells", "bladder stem cells", "prostate stem cells", "urethra stem cells", "cell therapy urology", "tissue engineering urology" y "regenerative medicine urology". RESULTS: We reviewed 30 articles published up to November 2009, trying to summarize thoroughly the most relevant findings and the last advances in this field, from the first steps to this day. CONCLUSION: Despite the great lack of knowledge existing, especially the need for achieving the identification of kidney, urothelium and prostate stem cells, this shouldn't prevent researchers from translating the laboratory results to the clinical work.

[Stem cells and regenerative medicine in urology, part 1: General concepts, kidney, testis and urinary incontinence]. / Células madre y medicina regenerativa en urología, 1.a parte: generalidades, riñón, teste e incontinencia.

INTRODUCTION: Progress in stem cell study and tissue engineering reached during the last times proves that this may be one of the most promising research fields in the future. Most urological diseases could profit from the development of disciplines such as regenerative medicine as, up to now, there have been encouraging results in this subject. MATERIAL AND METHODS: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: stem cells urology, kidney stem cells, testis stem cells, urinary sphincter, cell therapy urology, tissue engineering urology y regenerative medicine urology. RESULTS: We reviewed 33 articles published up to January 2010, trying to summarize the most relevant findings within the last years, the clinical applications and the point we have come to this day. CONCLUSION: Cell therapy and regenerative medicine are showing themselves to be one of the most promising fields within urological basic investigation in the last years. However, there is much work to be done yet, to make the advances reached in basic research be applicable to the clinic.

Células madre y medicina regenerativa en urología, 1. a parte: generalidades, riñón, teste e incontinencia / Stem cells and regenerative medicine in urology, part 1: General concepts, kidney, testis and urinary incontinence

Introducción: Los progresos alcanzados en los últimos años en el estudio de las células madre y la ingeniería tisular demuestran que probablemente se trate de unos de los campos de la investigación más prometedores para el futuro. Gran parte de las enfermedades urológicas podrían beneficiarse del desarrollo de disciplinas como la medicina regenerativa, pues en la actualidad ya se han conseguido resultados esperanzadores en esta materia. Material y métodos: Realizamos una búsqueda electrónica mediante la base de datos Pubmed, tanto de artículos originales como de revisiones, utilizando los criterios de búsqueda «stem cells urology», «kidney stem cells», «testis stem cells», «urinary sphincter», «cell therapy urology», «tissue engeneering urology» y «regenerative medicine urology». Resultados: Hemos revisado un total de 33 trabajos publicados hasta enero de 2010, intentando resumir los hallazgos más relevantes de los últimos años y su aplicación clínica, así como el punto en el que nos encontramos hoy en día. Conclusión: La terapia celular y la medicina regenerativa se están imponiendo como uno de los campos de investigación urológica más en auge en los últimos años. Sin embargo, queda aún mucho por investigar para que todos los rápidos avances de la investigación básica puedan ser trasladados a la clínica (AU)

Introduction: Progress in stem cell study and tissue engineering reached during the last times proves that this may be one of the most promising research fields in the future. Most urological diseases could profit from the development of disciplines such as regenerative medicine as, up to now, there have been encouraging results in this subject. Material and methods: We performed an electronic research through the Pubmed database, of both original and review publications, with the following search criteria: “stem cells urology”, “kidney stem cells”, “testis stem cells”, “urinary sphincter”, “cell therapy urology”, “tissue engeneering urology” y “regenerative medicine urology”. Results: We reviewed 33 articles published up to January 2010, trying to summarize the most relevant findings within the last years, the clinical applications and the point we have come to this day. Conclusion: Cell therapy and regenerative medicine are showing themselves to be one of the most promising fields within urological basic investigation in the last years. However, there is much work to be done yet, to make the advances reached in basic research be applicable to the clinic (AU)