Kidney Transplantation during the First Year of COVID-19 Pandemic in Our Center

Introduction: SARS-CoV2 pandemic has altered the normal activity in our day-to-day life. During the most critical moments of the pandemic at the hospital, attendance and programmed activities had to be reduced to a minimum, including kidney transplants. Hospitals with this kind of activity had to suspend or restructure it due to the decrease in the number of donors with a solid organ donation profile, the lack of knowledge as to whether the disease could be transmitted through transplantation or the risk that was believed to be associated with the admission of patients with end-stage chronic kidney disease or immunosuppressive treatment. Methods: A retrospective review of all patients who had received a kidney transplant at Doctor Peset University Hospital in Valencia was performed from March 2020 to March 2021. The objective was to study the safety of kidney transplantation and the incidence of COVID-19 disease in kidney transplant patients during this pandemic period. Results: 56 cases of kidney transplantation were included, most of them male with an average age of 56 years old, and variable comorbidity such as hypertension, dyslipidemia, an average body mass index of 26 and undergoing renal replacement therapy by hemodialysis. Regarding the organ donors, more than 50% were male patients and the donation was in encephalic death. The average cold ischemia time was 15 hours. Postoperative complications were mostly graded I and II in the Clavien-Dindo classification. 5.4% of the recipients had passed the SARS-CoV2 infection prior to the transplant and 5.4% were infected with COVID-19 after the transplant. Conclusion: In our experience, the current kidney transplant program seems viable and safe, even during periods of health emergencies (AU)

Introducción: La pandemia por SARS-CoV2 ha alterado la actividad habitual en nuestro día a día. Durante losmomentos más críticos de la pandemia a nivel hospitalariose tuvieron que reducir al mínimo la presencialidad y la actividad programada, incluyendo dentro de ésta el trasplanterenal. Los hospitales con dicha actividad tuvieron que suspenderla o bien reestructurarla debido a la disminución en elnúmero de donantes con perfil para la donación de órganossólidos, al desconocimiento de si la enfermedad podía transmitirse a través del trasplante o al riesgo que se creía quepodría conllevar ingresar pacientes con enfermedad renalcrónica terminal o en tratamiento inmunosupresor.Métodos: Se realizó una revisión retrospectiva de lospacientes que recibieron un trasplante renal en el Hospital Universitario Doctor Peset de Valencia desde marzo de2020 hasta marzo de 2021 con el objetivo de estudiar la seguridad del trasplante renal y la incidencia de enfermedadpor COVID-19 en los pacientes trasplantados renales durante este periodo de pandemia.Resultados: Se incluyeron 56 casos de trasplante renal, la mayor parte de ellos de sexo masculino, con una edadmedia de 56 años, un índice de masa corporal medio de 26 yen tratamiento renal sustitutivo mayoritariamente mediantehemodiálisis (50%). Con respecto a los donantes, más del50% eran de sexo masculino y la donación fue en muerteencefálica. El tiempo medio de isquemia fría fue de 15 horas. Las complicaciones posquirúrgicas fueron en su mayoría de grado I y II en la clasificación de Clavien-Dindo.Un 5.4% de los receptores habían pasado la infección porSARS-CoV2 previamente al trasplante y un 5.4% se infectaron por COVID-19 posteriormente al trasplante.Conclusión: En nuestra experiencia, parece viable yseguro el programa de trasplante renal vigente, incluso durante periodos de emergencia sanitaria. (AU)

20 años de experiencia en trasplante renal en bloque de donantes pediátricos en receptores adultos / A 20-year experience in cadaveric pediatric en bloc kidney transplantation in adult recipients

Introducción y objetivos El trasplante renal en bloque de donantes pediátricos en receptores adultos permite aumentar el pool de donantes, pero son pocos los centros que lo realizan. Mostramos los resultados de la técnica en nuestro centro tras su introducción en el año 1999.Material y métodos Análisis retrospectivo de los 42 procedimientos realizados en nuestro centro con una mediana de seguimiento de 73 meses (5-233) en los que se monitorizó la función renal de los pacientes y se registraron las complicaciones sucedidas.Resultados Se han realizado 42 trasplantes renales en bloque en adultos de donantes pediátricos en nuestro centro hasta el momento. La media de edad de los receptores fue de 44,1±11,8 años y la de los donantes de 22,4±14,7 meses, con un peso medio de 11,3±3,6kg. El tiempo medio de isquemia fría fue de 15,7±4,5 h. Al finalizar el seguimiento, 35 injertos eran funcionantes (83,3%) y mantenían una excelente función. Hubo 7 pérdidas de injerto (16,7%) en el postoperatorio inmediato (4 trombosis vasculares, una dehiscencia de anastomosis y 2necrosis corticales) y un fallecimiento durante el seguimiento por una causa no relacionada.Conclusiones El uso de injertos renales en bloque de origen pediátrico en adultos es un procedimiento seguro y con un excelente rendimiento funcional a medio y largo plazo. El postoperatorio inmediato es el periodo en el que se establecen la mayoría de las complicaciones importantes que pueden derivar en la pérdida del injerto. La adecuada selección de donantes y receptores, así como una correcta técnica quirúrgica, son imprescindibles para minimizar la aparición de eventos adversos (AU)

Background En bloc kidney transplantation from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of bloc kidney transplantation from pediatric donors into adult recipients in a single center.Material and methods Retrospective analysis of 42 patients who received pediatric cadaveric bloc kidney transplantation in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered.ResultsWe have performed 42 bloc kidney transplantation from pediatric donors into adult recipients in our center. The recipients’ age was 44.1±11.8 years. Pediatric donors were 22.4±14.7 months old and weighted 11.3±3.6kg. Cold ischemia time was 15.7±4.5hours. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99±0.25mg/dl). There were 7graft losses (16.7%) in the immediate postoperative period (4 cases of vascular thrombosis, one anastomosis dehiscence and 2cortical necrosis).Conclusions The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events (AU)

A 20-year experience in cadaveric pediatric en bloc kidney transplantation in adult recipients.

BACKGROUND AND OBJECTIVES: En bloc kidney transplantation (EBKT) from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of EBKT from pediatric donors into adult recipients in a single center. MATERIAL AND METHODS: Retrospective analysis of 42 patients who received pediatric cadaveric EBKT in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered. RESULTS: We have performed 42 EBKT from pediatric donors into adult recipients in our center. The recipients' age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 h. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were seven graft losses (16.7%) in the immediate postoperative period (four cases of vascular thrombosis, one anastomosis dehiscence and two cortical necrosis). CONCLUSIONS: The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.

[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.