[Donor outcomes after nephrectomy. Operative and postoperative morbidity--mortality and long-term impact of nephrectomy]. / Evolución del domante después de la nefrectomía. Morbi-mortalidad operatoria y postoperatoria e impacto a largo plazo de la nefrectomía.

The increase of living donor kidney transplants has prompted new interest for better knowledge of the risks of mobidity and mortality and long-term consequences of nephrectomy Peroperative morbidity varies in revised series, partially in relation to surgical technique: laparoscopic or open nephrectomy. We review the most frequent complications by surgical technique. In the long term, the causes of mortality among donors are similar to general population with aging.

Evolución del donante después de la nefrectomía. Morbi-mortalidad operatoria y postoperatoria e impacto a largo plazo de la nefrectomía / Donor outcomes after nephrectomy. Operative and postoperative morbidity-mortality and long-term impact of nephrectomy

El aumento de los trasplantes de donantevivo ha llevado al interes por conocer mejor el verdaderoriesgo de morbilidad y mortalidad y las consecuenciasa largo plazo de la nefrectomía. La morbilidadpreoperatoria difiere según las diferentes seriesrevisadas y en parte está relacionada con e tipo de técnicaquirúrgica empleada. Se revisan también las complicacionesquirúrgicas mas frecuentes según el tipo decirugía empleado : cirugía abierta o laparoscopia. Encuanto a las causas de mortalidad a largo plazo en losdonantes renales son similares a los de la poblacióngeneral según avanza la edad

The increase of living donor kidney ;;transplants has prompted new interest for better knowledge ;;of the risks of mobidity and mortality and long-term ;;consequences of nephrectomy. Peroperative morbidity ;;varies in revised series, partially in relation to surgical technique: laparoscopic or open nephrectomy. We ;;review the most frequent complications by surgical ;;technique. In the long term, the causes of mortality ;;among donors are similar to general population with ;;aging

[Multiple complications after renal transplantation]. / Complicaciones múltiples post-trasplante renal.

This is the case of a 32-year-old male patient, diagnosed with end stage renal disease secondary to a focal and segmental glomerulonephritis. After four years of haemodialysis, he received a renal graft from a cadaveric donor. During the following sixteen years, he developped many different complications. In the early post-transplant period, he developed a severe acute tubular necrosis and two episodes of acute rejection took place, both of them with later recovery. Among the outstanding infectious complications were a virus herpes zoster dorsal infection and a Pseudomonas aeruginosa nosocomial pneumonia. Twelve months later, a series of severe digestive complications took place: cholecystitis that required cholecystectomy, pancreatic pseudocyst which required laparotomy because of an abdominal complication, two separate episodes of upper digestive bleeding that finally required gastric surgery, and an hemorrhagic subphrenic abscess that required a second laparotomy. Currently he has developed a calcified chronic pancreatitis. Moreover, metabolic complications must be mentioned carbohydrate intolerance, cataracts and an avascular bone necrosis, all of them closely related to the immunosuppressive therapy. In spite of these multiple complications, he mantains a good renal function and his quality of life is acceptable.

Complicaciones múltiples post-trasplante renal / Complicaciones múltiples post-trasplante renal

Paciente de 32 años, con insuficiencia renal crónica terminal secundaria a glomerulonefritis primaria segmentaria y focal, fue trasplantado con injerto de donante cadáver en mayo de 1986, tras cuatro años de hemodiálisis domiciliaria. Durante los 16 años de evolución ha desarrollado gran número de complicaciones. En el postoperatorio presentó una necrosis tubular aguda y dos episodios de rechazo agudo con recuperación en ambos casos. Posteriormente como complicaciones infecciosas destacan una infección costal por herpes zoster y neumonía nosocomial por pseudomona aureginosa. A los doce meses post-trasplante inicia un serie de complicaciones digestivas graves, colecistitis (colecistectomía), pseudoquiste pancreático (rotura y laparotomía evacuadora) hemorragia digestiva alta en dos ocasiones (cirugía gástrica), absceso subfrénico hemorrágico (laparotomía evacuadora). Actualmente padece pancreatitis crónica calcificada. Importante patología relacionada con la toma de inmunosupresores, de tipo metabólico (intolerancia hidrocarbonada), cataratas, necrosis avascular bilateral de caderas. El paciente presenta en la actualidad una función renal y una calidad de vida aceptables a pesar de todas las complicaciones descritas (AU)

This is the case of a 32 years old male patient, diagnosed with end stage renal disease secondary to a focal and segmental glomerulonephritis. After four years of haemodialysis, he received a renal graft from a cadaveric donor. During the following sixteen years, he developped many different complications. In the early post-transplant period, he developped a severe acute tubular necrosis and two episodes of acute rejection took place, both of them with later recovery. Among the infectious complications, to throw into relief a virus herpes zoster dorsal infection and a pseudomona aeruginosa nosocomial pneumonia. Twelve months later, a serie of severe digestive complications took place: cholecystitis that required cholecystectomy, pancreatic pseudocyst wich required la parotomy because of an abdominal complication, two separate episodes of upper digestive bleeding that finally required gastric surgery, and an hemorragic subfrenic abscess that required a second laparotomy. Currently he has developed a calcified chronic pancreatitis. Moreover, metabolic complications must be mentioned as hydrocarbonated intolerance, cataracts and an avascular bone necrosis, all of them closely related to the inmunosupressive therapy. In spite of these multiple complications, he mantains a good renal function and his quality of life is aceptable (AU)

Autosomal-dominant polycystic kidney disease: high prevalence of graft loss for death-related malignancies and cardiovascular risk factors.

Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disease with multiple extrarenal manifestations. It accounts for 7% to 11% of patients receiving dialysis or renal transplantation (RT) for end-stage renal disease (ESRD) in Europe. We analyzed retrospectively the causes of death, the prevalence of cardiovascular risk factors (CVRF) and the patient and graft survivals in 62 consecutive ADPKD patients who received 63 cadaveric grafts (29 men and 34 women), of the 600 RTs performed between 1980-2001. The diagnosis of ADPKD was established by family history and ultrasound techniques. At present, 50 patients (79.4%) have functioning grafts, with a mean follow-up of 84.7 months (range, 12-255), and 13 patients have lost their grafts. The main cause of failure was patient death with a functioning graft (9 cases). Malignancies occurred in 5 patients, including 2 lymphomas, 1 renal carcinoma, 1 pancreas sarcoma, and 1 lung cancer associated with infection. Three patients died of cardiocerebrovascular events, and 1 patient of pneumonia. One patient lost the graft after decreasing the immunosuppression for an obstructing colon cancer. Three additional patients now on dialysis lost their grafts due to chronic rejection in 2 cases and primary nonfunction in 1 case. The prevalence of cardiovascular risk factors among the 50 patients with functional grafts were: hypertension, 70%; hypercholesterolemia, 62%; hyperhomocysteinemia, 30%; hyperfibrinogenemia, 68%; increased lipoprotein (a), 18%; microalbuminuria, 22%; hyperuricemia, 48%; hyperparathyroidism, 24%; overweight status, 24%; and nonlethal myocardial infarction, 10%. We conclude that ADPKD patients have good graft and patient survivals, and that the presence of malignancy is the main cause of death and graft failure at our center.

Treatment of hyperhomocysteinemia after renal transplantation.

INTRODUCTION: Several epidemiologic prospective studies have provided strong evidence that hyperhomocysteinemia (HHC) is a risk factor for cardiovascular disease (CVD) due to its role in producing endothelial damage due to oxidation stress. Several studies show that combined folic acid (FA) and vitamin B12 (B12) treatment decreases fasting total homocysteine (HC) levels in renal transplant recipients (RTR). The aim of the study was to determine the efficacy and safety during one year of combined FA and B12 treatment in 89 RTR, as well as the relationship between HHC with other known risk factors for CVD and the intrinsic characteristics of the transplantation. METHODS: Among 193 RTR in whom we determined the baseline levels of HC, FA, B12, creatinine, and CV risk factors, 81 had normal (HC < 14 micromol/L) and 112 elevated (HC > or = 14 micromol/L) HC levels, 89 of whom were included in a treatment group (23 nontreated). Analytic measures were performed at baseline and 1, 3, and 12 months. RESULTS: We observed a decrease in HC levels among the treatment group (P<.05) after 12 months without differences in the other groups. There were no differences in age, hypertension, hypercholesterolemia, smoking, presence of diabetes, or type of immunosuppression between the groups. There was a significant correlation between basal creatinine and HC level (P<.05). A higher prevalence of CVD was observed in the HHC group (P<.05). CONCLUSION: HHC is associated with worse renal function and a higher prevalence of CVD. FA and B12 treatment normalize HC levels, representing a safe treatment that could improve the long-term vascular prognosis of RTR.