Fate of finally transplanted deceased donor kidneys initially rejected at other kidney transplantation centers.

OBJECTIVE: We conducted this study to determine whether it is justifiable for transplant centers to reject cadaveric donor organs based on marginal organ quality. There is a growing discrepancy between the demand for renal transplants and the number of transplants conducted. For the many patients on the renal transplant waiting list, this translates into increased dialysis-associated morbidity, mortality and a reduced quality of life. PATIENTS AND METHODS: In our retrospective analysis, we focused on deceased donor kidneys that had been rejected in other transplant centers because of poor organ quality (111 patients) and then accepted for transplantation at our center, compared with a control group consisting of 343 patients. RESULTS: Cold ischemia time was statistically significantly shorter in the control group (11 vs. 12.5 h, p = 0.005). Also, delayed graft function occurred significantly (p = 0.004) more often in the study group (45.9-30.3%). Parameters regarding perioperative data and recipient outcome did not show significant differences and except for 2 time points at 1 week and 3 months, graft function did not differ either. CONCLUSIONS: We propose that acceptance criteria for marginal donor kidneys should be expanded. Centers should reconsider their acceptance criteria in the light of these findings as the results of these transplantations may even be much better if the delay due to reallocation and retransport can be spared.

miR-199a-3p and miR-214-3p improve the overall survival prediction of muscle-invasive bladder cancer patients after radical cystectomy.

To improve the clinical decision-making regarding further treatment management and follow-up scheduling for patients with muscle-invasive bladder cancer (MIBC) after radical cystectomy (RC), a better prediction accuracy of prognosis for these patients is urgently needed. The objective of this study was to evaluate the validity of differentially expressed microRNAs (miRNAs) based on a previous study as prognostic markers for overall survival (OS) after RC in models combined with clinicopathological data. The expression of six miRNAs (miR-100-5p, miR-130b-3p, miR-141-3p, miR-199a-3p, miR-205-5p, and miR-214-3p) was measured by RT-qPCR in formalin-fixed, paraffin-embedded tissue samples from 156 MIBC patients who received RC in three urological centers. Samples from 2000 to 2013 were used according to their tissue availability, with follow-up until June 2016. The patient cohort was randomly divided into a training (n = 100) and test set (n = 56). Seventy-three samples from adjacent normal tissue were used as controls. Kaplan-Meier, univariate and multivariate Cox regression, and decision curve analyses were carried out to assess the association of clinicopathological variables and miRNAs to OS. Both increased (miR-130b-3p and miR-141-3p) and reduced (miR-100-5p, miR-199a-3p, and miR-214-3p) miRNA expressions were found in MIBC samples in comparison to nonmalignant tissue samples (P < 0.0001). miR-199a-3p and miR-214-3p were independent markers of OS in Cox regression models with the significant clinicopathological variables age, tumor status, and lymph node status. The prediction model with the clinicopathological variables was improved by these two miRNAs in both sets. The predictive benefit was confirmed by decision curve analysis. In conclusion, the inclusion of both miRNAs into models based on clinical data for the outcome prediction of MIBC patients after RC could be a valuable approach to improve prognostic accuracy.

Successful repair of post-transplant mycotic aneurysm of iliac artery with renal graft preservation: a case report.

OBJECTIVE: To describe the successful repair of a post-transplant iliac artery aneurysm with renal graft preservation. METHODS: An aneurysm was detected in an asymptomatic 47-year-old male recipient on routine Doppler ultrasonography that involved the right external iliac artery and the distal portion of the renal artery. Aneurysm resection was performed immediately after diagnosis 3 months after transplantation. A polytetrafluorethylene tube graft was used for reconstruction of the right external iliac artery. Reconstruction of the renal artery required interposition of a vena saphena graft between the proximal portion of the renal artery and the polytetrafluorethylene tube. RESULTS: The total warm ischemia time used for aneurysm repair and renal transplant revascularization was 90 minutes. The postoperative Doppler ultrasound scan showed homogeneous graft perfusion. Pathologic and microbiologic examination of the resected aneurysm revealed Candida albicans arteritis. The center in which the contralateral donor kidney was transplanted had previously reported Candida albicans contamination of the preservation solution. The recipient of the contralateral kidney lost his graft owing to bleeding complications. Information on this incident was acquired by our center only after aneurysm repair. Postoperatively, our recipient was given systemic antifungal therapy. At 6 months, the serum creatinine level was 1.7 mg/dL. CONCLUSION: Although a high-risk procedure, repair of a mycotic aneurysm with renal graft preservation is feasible. Routine microbiologic screening of the preservation solution might help to detect and treat donor-transmitted infections in renal transplant recipients.

Novel low-cost prostate resection trainer-description and preliminary evaluation.

BACKGROUND: Transurethral resection of the prostate (TURP) is a challenging operation for residents with limited endoscopic experience. A number of virtual TURP simulators have been validated in the past. This study is the first description and preliminary evaluation of a non-virtual, low-cost TURP trainer as a teaching tool for residents in urology. METHODS: Dr K. Forke's prostatic resection trainer (PRT; LS 10-2/S, Samed GmbH, Dresden, Germany) was tested during the surgical training of a resident. Under the supervision of an experienced senior surgeon, three aspects were examined: the resection trainer's approximation to reality, the ease of instruction, and the potential capability to improve surgeons' psychomotor abilities with regard to the three-dimensional (3D) guidance of the instrument. The improvement in resection speed (RS) of residents with no PRT training (control group) was also compared to the results of the PRT-trained resident. RESULTS: During the PRT training, the resident displayed clear improvement in resection quality (RQ) and a 27% increase in RS (p = 0.03). In the post-training stage, the PRT-trained resident showed a more constant progress rate, to a maximum RS of 0.37 g/min (35% increase; p = 0.01), whereas the control group displayed varied RS learning curves. Composed of a synthetic material, which can be resected by standard instruments, the trainer offers a haptical experience that is particularly realistic and may provide an increased learning rate. CONCLUSION: From the findings, we conclude that this novel PRT is suitable for daily use and offers an effective and more affordable alternative to virtual simulators. Further validation studies will follow and new fields of application will be tested.