Consensus on definition and severity grading of lymphatic complications after kidney transplantation.

BACKGROUND: The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS: Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS: Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION: A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.

ANTECEDENTES: La incidencia de complicaciones linfáticas tras el trasplante renal (post-kidney-transplantation lymphatic, PKTL) varía considerablemente en la literatura. Esto se debe en parte a que no se ha establecido una definición universalmente aceptada. Este estudio tuvo como objetivo proponer una definición aceptable para las complicaciones PKTL y un sistema de clasificación de la gravedad basado en la estrategia de tratamiento. MÉTODOS: Se realizó una búsqueda sistemática de la literatura relevante en MEDLINE y Web of Science. Se logró un consenso para la definición y la clasificación de gravedad de las PKTL entre veinte centros de trasplante de alto volumen. RESULTADOS: En 32 de los 87 estudios incluidos se definía la linforrea/linfocele. Sesenta y tres artículos describían como se trataban las PKTL, pero ninguno calificó la gravedad de las mismas. La definición propuesta para la linforrea fue la de un débito diario superior a 50 ml de líquido (no orina, sangre o pus) a través del drenaje o del orificio cutáneo tras su retirada, más allá del 7º día postoperatorio del trasplante renal. La definición propuesta para linfocele fue la de una colección de líquido de tamaño variable adyacente al riñón trasplantado, tras haber descartado un urinoma, hematoma o absceso. Las PKTL de grado A fueron aquellas con escaso impacto o que no requirieron tratamiento invasivo; las PKTL de grado B fueron aquellas que precisaron intervención no quirúrgica y las PKTL de grado C aquellas en que fue necesaria la reintervención quirúrgica. CONCLUSIÓN: Se propone una definición clara y una clasificación de gravedad basada en la estrategia de tratamiento de las PKTLs. La definición propuesta y el sistema de calificación en 3 grados son razonables, sencillos y fáciles de comprender, y servirán para estandarizar los resultados de las PKTL y facilitar las comparaciones entre los diferentes estudios.

Popliteal endarterectomy at the leg level with venous enlargement patch: about 14 cases.

The incidence of lesions of the popliteal artery below the knee constitutes one of the greatest problems in revascularization of the lower limb. Firstly, this segment constitutes the departure of the leg tripod, decisive crossroads for a subsequent endovascular intervention. On the other hand, it constitutes a fairly used relay point in the event of an indication for a pedal bypass. It is assumed that the performance of a popliteal endarterectomy with an enlargement by medial approach in patients with a localized lesion at this level constitutes an effective therapeutic approach and can facilitate any gesture of crural bypass or endovascular dilation later. We present a retrospective review of all patients who underwent popliteal endarterectomy with venous patch plasty for localized popliteal disease in our institution over the past 3 years.

[Chemotherapy-associated steatohepatitis in patients with colorectal cancer and surgery on hepatic metastasis: clinical validation of a histopathological scoring system and preoperative risk assessment]. / Chemotherapieassoziierte Leberveränderungen bei Patienten mit kolorektalem Karzinom und operativer Entfernung von Lebermetastasen: Evaluierung eines histopathologischen Scores und Erhebung präoperativer Risikofaktoren.

Colorectal cancer (CRC) can only be cured by complete resection of the tumour. Primarily unresectable metastases of the liver are treated by chemotherapy to achieve down-sizing of metastasis and curative resection. Chemotherapy can affect tumour-free healthy liver tissue and lead to histopathological and functional changes summarised as "chemotherapy-associated steatohepatitis" (CASH). We have evaluated a histopathological scoring system for CASH and searched for preoperative risk factors for the development of CASH. Liver alterations such as CASH were more pronounced when patients received chemotherapy, especially when treated with oxaliplatin. A higher BMI, male sex and elevated serum transaminases were risk factors for the development of CASH. Patients with a higher CASH score, reflecting more advanced changes in liver tissue, had a higher serum peak bilirubin level postoperatively. We did not find a higher morbidity or mortality in patients with a more severe liver damage measured by the CASH score.

Laparoscopic radioisotope-guided sentinel lymph node mapping and excision of the rectum--an experimental study.

BACKGROUND: Patients with a low-risk T1 rectal carcinoma can undergo the therapy of a local excision. In these patients the lymph node (LN) status remains unknown. There is a potential risk of up to 7% for nodal metastasis. To investigate the possibility of using the sentinel lymph node (SLN) concept, an experimental study on pigs was undertaken. The objective was to laparoscopically identify and extract SLNs from the rectum using a radioisotope (RI). METHODS: The experiment was conducted in 30 pigs, since the sample size calculation indicated that with 30 animals a two-sided 95% confidence interval for a single proportion using the large sample normal approximation would extend at most 0.107 from the observed proportion of 0.9. One milliliter of a mixture of the RI Technetium 99 m (Tc99 m) and patent blue V dye was administered in the rectum endoscopically and after the lapse of 1 h, we laparoscopically identified and excised all SLNs using a laparoscopic gamma camera probe. RESULTS: We found in all operated pigs (n = 30) at least one SLN (lymph node with highest measured counts per second (cps)). In mean we detected 1.6 SLN (range one to three SLNs). In 28 cases, the SLN concept was successful. Sensitivity for detecting SLNs was 93% (n = 28/30), the probe count rate ranged from 600-10,000 cps with a median of 3,800. CONCLUSION: Minimal invasive mapping and excision of SLN of the rectum using a RI is feasible. The sensitivity for detecting SLN was high (93%). The application of this procedure on humans seems to be possible.

[Pancreas and islet transplantation. The role in the treatment of diabetes mellitus]. / Pankreas- und Inseltransplantation : Stellenwert in der Therapie des Diabetes mellitus.

Diabetes mellitus is a chronic disease often leading to microvascular and macrovascular complications. There is evidence that better glycemic control by intensive insulin treatment effectively delays onset and slows the progression of diabetic complications. Despite great investigations and improvements in islet transplantation, long-term insulin independence has not been achieved in the majority of patients. Currently the only reliable option for establishing durable normoglycemia in patients with type 1 diabetes mellitus is whole pancreas transplantation. Simultaneous pancreas-kidney transplantation (SPK) has become the therapy of choice for patients with end-stage renal disease and type 1 diabetes mellitus. Over the past 20 years, outcomes of SPK have improved significantly to the point that the majority of recent data demonstrate long-term survival benefits and some protection from progressing secondary complications.

Long-term results after simultaneous pancreas-kidney transplantation using donors aged 45 years or older.

UNLABELLED: With the shortage of organ donors, there is a critical need to use all available pancreas grafts for transplantation. METHODS: From June 1994 to December 2006 we performed 340 pancreas transplantations (317 simultaneous pancreas-kidney 5 pancreas only, 18 pancreas after kidney) including 69 (20%) transplantations from donors aged 45 years or older. Pancreas grafts from older donors were analyzed for graft and patient survival as well as surgical complications, compared with results from younger donors. RESULTS: Recipient characteristics were comparable in both groups. The older donor group mean age was 47.8 years (+/-2.1) versus 27.9 years (+/-10.3) for the younger group. Cumulative patient survival was 96% versus 98% after 1, 82% versus 91% after 5 and 82% versus 88% after 10 years with 1-5- and 10-year kidney graft survivals of 82%, 72%, 57% versus 93%, 83%, 73%, respectively. Pancreas transplant survival after 1, 5, and 10 years were 69%, 60%, 45% in older and 88%, 76%, and 72% in younger donor cohorts. There were 14 (20%) cases of venous thrombosis in the older group and 25 (9%) in the younger group (P = .012). CONCLUSION: Our results demonstrated that utilization of pancreas grafts from donors over 45 years resulted in acceptable outcomes after simultaneous pancreas-kidney transplant and could expand the donor pool. Among the older donor group, patient survival was slightly lower than the younger group, whereas pancreas graft function was significantly inferior (P < .01). Since venous thrombosis was the main reason for pancreas graft loss in older group, anticoagulation is essential.

Nitric oxide restores impaired healing in normoglycaemic diabetic rats.

OBJECTIVE: Hyperglycaemia impairs wound healing. However, little is known about the underlying cellular mechanisms that lead to diminished wound repair in insulin-controlled and non-insulin-controlled diabetes. This study investigated the role of endogenous and exogenous nitric oxide on incisional wound healing in diabetic rats. METHOD: Groups of 10 wild-typeWistar control rats - 10 genetically diabetic BioBreeding rats and 10 genetically diabetic BioBreeding rats treated with subcutaneous insulin implants to render them normoglycaemic - underwent dorsal skin incision followed by subcutaneous insertion of polyvinyl alcohol sponges. The rats were sacrificed 10 days later to determine the wound-breaking strength and reparative collagen deposition. Nitric oxide, an important mediator in diabetic wound healing and collagen synthesis, was measured in wound fluid. Wound-derived fibroblasts were tested for ex vivo synthesis of nitric oxide and collagen. Exogenous nitric oxide was used for the therapeutic interventions. RESULTS: Wound-breaking strength and wound collagen deposition were significantly impaired in the hyperglycaemic diabetic animals (p<0.01). Wound nitric-oxide synthesis and ex vivo wound fibroblast nitric-oxide production were reduced in the hyperglycaemic rats (p<0.01). Insulin treatment partially reversed some of the effects of hyperglycaemia on wound repair (p<0.05). Exogenous nitric oxide further restored wound mechanical strength, collagen deposition and fibroblast collagen synthesis (p<0.01) in insulin-treated (normoglycaemic) diabetic animals. CONCLUSION: Wound healing is impaired in hyperglycaemic and normoglycaemic diabetic rats. This is reflected in impaired wound fibroblast nitric-oxide synthesis. Used in combination with insulin, exogenous nitric oxide further improves healing outcomes, making it a potential target for therapeutic intervention in insulin-treated normoglycaemic diabetes.

[Simultaneous pancreas-kidney transplantation. Influence of donor and recipient gender]. / Kombinierte Nieren-Pankreas-Transplantation. Einfluss des Spender- und Empfängergeschlechts.

BACKGROUND: Differences in graft survival due to gender have been reported after transplantation of the kidney, liver, and heart. However, little is known about the role of donor and recipient gender in simultaneous pancreas-kidney transplantation. METHODS: Single-centre analysis was performed of first simultaneous pancreas-kidney transplantations performed between 1994 and 2005 at the Bochum Transplant Center in Germany (n=218). RESULTS: Recipients of female donor organs exhibited acute organ rejections earlier and more frequently (P<0.05). Male recipients of organs from male donors had a lower risk of acute rejection than recipients of female donor organs (P<0.05). In addition to female donor gender, higher donor age and early kidney dysfunction were risk factors for perioperative rejection (P<0.05). Long-term kidney and pancreas function was best in male-donor-to-female-recipient transplants over the time periods of 7 and 3 years, respectively (P<0.05). Risk factors of long-term organ failure were: the need of revision laparotomy, organ rejection, and early postoperative organ dysfunction (P<0.05). CONCLUSION: This is the first report of graft function after simultaneous pancreas-kidney transplantation looking specifically at gender differences with respect to donor and recipient. There was an increased risk of organ rejection of female donor organs.

Successful Simultaneous Pancreas-Kidney Re-transplantation in a Highly Human Leukocyte Antigen-Sensitized Patient.

BACKGROUND: The waiting time for re-transplantation for sensitized patients is greatly prolonged, given the lack of transplants that are available for this group and additional immunologic barriers. We report the case of a successful re-transplantation in a patient with very high levels of panel reactive antibodies ([PRA] >85%). METHODS: A 45-year-old woman had repetitive rejections after simultaneous pancreas-kidney transplantation, with consequent loss of function of both transplanted organs. Because of a symptomatic episode of kidney rejection, additional removal of the transplanted kidney was performed 6 years later. Because our patient had a very high PRA level, she was enrolled in a desensitization protocol. The regimen was based on an initial single dose of rituximab, followed by repetitive plasmapheresis/immune-absorption sessions and intravenous substitution of immunoglobulin. Eight cycles were required, until a cross-match test was negative (PRA level <50%). The protocol included prednisolone and weight-adapted thymoglobulin. The basic immunosuppressive medication consisted of prednisolone, tacrolimus, and mycophenolate mofetil. The patient's postoperative course was uneventful. RESULTS: Preoperative treatment is essential for sensitized patients. There are no prospective, randomized trials comparing all suggested desensitization protocols. The main tenets of every approach are plasmapheresis and intravenous substitution of immunoglobulin, which appear to have a strong immunomodulatory effect. In the case of re-transplantation, the clinical surgeon not only faces special technical and surgical challenges but also must confront immunologic barriers. CONCLUSIONS: Pancreas-kidney transplantation in patients with high PRA levels is feasible and can be performed successfully with novel desensitization protocols.

[Pancreas removal by external teams]. / Pankreasorganentnahme durch externe Teams.

Combined pancreas and kidney transplantation is an established procedure for terminal or preterminal, uremic, type 1 diabetics. The current procurement technique allows simultaneous recovery of liver and pancreas. One problem is the assessment of organ quality. It remains unclear how many pancreas organs must be withdrawn during back-table preparation. Between June 1994 and December 2003, 271 pancreas transplantations were performed at our transplant centre. Two hundred sixty-two (89.7%) pancreas grafts were harvested by teams which were not part of the transplant team. Twenty-one (8.0%) grafts were discharged for transplantation at the time of back-table preparation. Liposis of the graft and critical vessel situations were the main reasons for withdrawal. Two kidney grafts were not usable for transplantation, and 92% of the pancreas grafts were. This demonstrates the high standard of pancreas procurement in the Eurotransplant region.

Loss of cyclin A and G1-cell cycle arrest are a prerequisite of ceramide-induced toxicity in human arterial endothelial cells.

BACKGROUND: Ceramide is an important messenger of TNF- and lipid-induced apoptosis. We previously demonstrated the adverse effect of TNF in the process of reendothelialization as well as the dependence of its effect on cell-cycle regulation. The current study was designed to investigate the linkage between ceramide induced toxicity and growth arrest in human endothelial cells. METHODS AND RESULTS: Cultured human arterial endothelial cells (HAEC) served as an in-vitro model to test the cellular effects of C2-ceramide (C2). C2-induced cell death in HAECs occurred time- and dose-dependently. The LD(50) in subconfluent cells was three times lower than in confluent cell layers (25 vs. 75 microM). C2 caused up to 70% inhibition of BrdU and [3H]thymidine incorporation at non-toxic concentrations as a result of G1 cell-cycle arrest. Downregulation of cyclin A and p21(Cip1/Waf1) protein expression was observed independently of C2-toxicity, while expression of other cell-cycle regulatory genes was not affected. Inhibition of cyclin A protein expression by sequence-specific antisense-oligonucleotides was paralleled by significant growth-inhibition. The protein phosphatase inhibitor okadaic acid induced endothelial cell proliferation, which was completely abrogated by C2. In contrast, aphidicolin-synchronized endothelial cells demonstrated elevated cyclin A levels along with 30% higher BrdU-incorporation and 70% less C2-toxicity. G1-arrested cells, however, showed significantly enhanced C2-toxicity, lack of cyclin A expression and induction of uncleaved caspase-3 (CPP32). CONCLUSIONS: Ceramide abrogates endothelial cell proliferation independently of apoptosis or necrosis at low concentrations (

All-trans retinoic acid regulates proliferation, migration, differentiation, and extracellular matrix turnover of human arterial smooth muscle cells.

OBJECTIVE: The vitamin-A derivative all-trans retinoic acid (atRA) is a potent regulator of cell growth, differentiation, and matrix formation of various cell types and plays an important role in embryogenesis. However, sparse data are available about its effects on human vessel diseases. Thus, we studied the effects of atRA on human arterial smooth muscle cell (haSMC) and endothelial cell (haEC) proliferation, migration, differentiation and extracellular matrix (ECM) turnover in mono- and transfilter cocultures. METHODS: Effects of atRA on human arterial cells in monocultures were determined using cell counting assays, BrdU-ELISA and MTT-tests. In transfilter cocultures haSMC-growth was studied under the stimulatory effect of proliferating haEC. Using Northern blot analysis, effects of atRA on mRNA expression of ECM-proteins were examined while protein expression and activity of matrix metalloproteinases were determined by Western blotting and zymography. RESULTS: atRA caused a dose dependent inhibition of haSMC-growth in monocultures (IC(50) at 0.022 microM) whereas haEC-growth was inhibited less potently (IC(50) at 97 microM). In addition, proliferation and migration of haSMC through a porous membrane were inhibited dose dependently by micromolar atRA-doses after non-stop and single dose application of atRA on the endothelial side of the complex transfilter coculture system. Immunostainings and Northern blotting demonstrated an enhanced alpha-smooth muscle actin and heavy chain myosin expression in haSMC after atRA-treatment. Whereas mRNA-expression of the glycoproteins thrombospondin-1 and fibronectin were decreased, collagen-1 mRNA expression was even slightly stimulated. Transcription of biglycan and TGF-beta1 were not influenced in a specific manner. Finally, protein expression and activity of the matrix metalloproteinases MMP-2 and MMP-9 were inhibited significantly by atRA. CONCLUSIONS: atRA was found to be a potent inhibitor of both haSMC-proliferation and -migration, even in coculture with haEC releasing growth factors. In addition, redifferentiation, ECM synthesis and ECM degradation were regulated by atRA which also influence haSMC migration and intima formation. Thus, atRA-treatment seems to be a promising strategy for the inhibition of processes involved both in atherosclerosis and restenosis.

Release of TNF-alpha from lipopolysaccharide (LPS)-stimulated Kupffer cells in serum- and nutrient-free medium.

In monocytes/macrophages LPS stimulation occurs by the binding of LPS and the serum component LPS-binding protein (LBP) to CD14. This study was conducted to investigate whether this mechanism also occurs in Kupffer cells. Rat Kupffer cells were stimulated for up to 8 h by LPS (0, 100 ng/ml, 10 microg/ml) in RPMI medium or in nutrient-free Krebs-Henseleit (KH) buffer. Some incubations were performed without serum, while in others serum was provided. TNF-alpha concentrations of the supernatants were measured by ELISA. LPS stimulation of Kupffer cells yielded the following results. In KH without any additives a considerable amount of TNF-alpha was released. Incubation in RPMI without serum caused twice as much TNF-alpha to be released as when KH was used. The addition of autologous serum to RPMI did not increase TNF-alpha response. These results provide evidence that a substantial part of TNF-alpha release by LPS-stimulated Kupffer cells occurs in a serum- and thus LBP-independent way.

Thymus carcinoid.

A carcinoid of the thymus was studied by light- and electron-microscopy, immunohistology and flow-cytometry. The tumor showed a ribbon- and festoon-like growth-pattern with foci of necrosis, invasion of vessels and infiltration of mediastinal lymph nodes. The cytoplasma of the tumor-cells contained neuroendocrine granula and immunohistochemistry of ACTH was positive. The tumor-cells were connected by desmosomes, correlating to a pre-keratin positive immunohistology. In flow-cytometry the tumor-cells showed a near haploid DNA aneuploidy which is an extremely rare finding in solid tumors and in the few cases described indicative for treatment resistance.

[Contrast-enhanced MR cholangiography in percutaneous bile duct drainage]. / Kontrastverstärkte MR-Cholangiographie bei perkutaner Gallenwegsdrainage.

PURPOSE: To evaluate MR-cholangiography after instillation of contrast media via indwelling biliary tubes. METHODS: In 8 patients with stenoses of the central bile ducts, physiological saline solution and diluted contrast media (Gd-DTPA, 5 mmol/l) were consecutively administered via an indwelling biliary tube. MR cholangiograms were obtained before and after saline injection using a HASTE-sequence and after administration of Gd-DTPA using a T1-weighted gradient echo sequence. RESULTS: Peripheral bile ducts were better visualised in the water-sensitive approach than after Gd-DTPA enhancement. In patients with short-time drainage bile duct definition was poor due to periportal oedema. Visualisation of peripheral bile ducts could be improved by injection of saline solution in these patients. After administration of Gd-DTPA via the biliary tube contrast enhancement of the central bile ducts was achieved in all patients except for one patient on long-term drainage with an indwelling Yamakawa tube. CONCLUSION: T1-weighted visualisation of the central bile ducts can be achieved by means of injection of Gd-DTPA via indwelling biliary tubes.

Impairment of renal function following liver transplantation.

BACKGROUND: Although renal insufficiency following liver transplantation is not infrequent, only limited reports describe the incidence and progression of the kidney disease. METHODS: This single-centre retrospective analysis after successful liver transplantation between January 1985 and March 2002 defined the baseline serum creatinine at 50 days after liver transplantation to represent the renal function. The primary end-point was an increase of serum creatinine by more than 50% above the baseline. RESULTS: Long-term data were available for 162 patients (84 women, 78 men) who received 167 liver transplants. The median serum creatinine level at 50 days after liver transplantation was 1.0 mg/dL (range 0.5-3.5 mg/dL). The median serum creatinine increased to 1.2 mg/dL (0.4-9.8 mg/dL) at the end of follow-up. Six patients (4%) experienced end-stage renal failure. Forty-one patients (25%) showed a 50% increase in the serum creatinine. Kaplan-Meier analysis revealed that 43% and 48% of patients had a deterioration of renal function at 10 and 15 years after liver transplantation, respectively. Patients at risk showed an increase of serum creatinine by 0.25 mg/dL/y. Only the recipient age was an independent risk factor for deterioration of renal function. CONCLUSIONS: Although there is a high risk for the impairment of renal function after liver transplantation, progression of renal disease is slow and rarely results in end-stage renal failure within 10-15 years. However, patients at risk should be identified early to prevent further decline in renal function.

The potential role of reactive oxygen species in liver ischemia/reperfusion injury following liver surgery.

Reperfusion of a previously ischemic tissue may lead to an aggravation of injury. The liver has been shown to be susceptible to this reperfusion injury in several experimental systems. Reactive oxygen species appear to play an important role in the development of such injury, as has been demonstrated by direct measurements of their release, and by the protective effects of antioxidants. Upon reperfusion, reactive oxygen species may be released by hepatocytes, Kupffer cells and neutrophils. The relative contribution of the various liver cell types to the release of reactive oxygen species depends on several factors, including the duration and condition of ischemia and the time elapsed after reperfusion. There is only limited evidence for the occurrence of reperfusion injury in humans following liver surgery. The role of reactive oxygen species in this injury in humans remains to be shown.

Cultivation of porcine hepatocytes in polyurethane nonwovens as part of a biohybrid liver support system.

Many patients suffering from end-stage liver disease cannot be transplanted within reasonable time due to the shortage of donor organs. Bioartificial liver support systems may contribute to the liver regeneration or bridging the time until a liver graft for transplantation becomes available. Nonwovens with integrated oxygenation capacity have been developed and manufactured by melt blow technology using thermoplastic polyurethane. Capillary membranes for oxygenation were integrated into the nonwoven during the processing. The polyurethane nonwoven structures with adapted pore size and high pore volume allow high cell densities in the hepatocyte culture. The three-dimensional cell culture was housed by a flow bioreactor system and was integrated in a closed loop circulation with monitoring possibilities for pressure, pH, temperature, ammonia, and oxygen. Hepatocytes were isolated from rats or pigs by collagenase perfusion and infused into the medium-perfused circulation. Cells showed high viability and hepatocyte specific cytochrome P450-dependent metabolic function in culture (MEGX test).

[Acute cholecystitis in a traumatologic patient sample]. / Akute Cholezystitis im traumatologischen Krankengut.

Among the patients of the Accident Hospital of the Co-operative Trade Association Tübingen, there were 11 cases of acute cholecystitis between 1985 and 1991. Acute cholecystitis occurred after polytrauma (n = 5), multiple fractures (n = 2), head injury (n = 1), fracture of femoral neck (n = 1) or elective hip surgery (arthrodesis, total hip replacement) (n = 2). The mean age was 57 (16-89) years, acute cholecystitis was confirmed 27 (6-54) days after trauma of surgery. 7 cases presented as acute acalculous cholecystitis, whereas in 4 cases of acute cholecystitis cholecystolithiasis was present. 9 patients were treated via cholecystectomy; one juvenile paraplegic recovered after conservative treatment, one 82-year old female was in too bad condition for surgery so that percutaneous cholecystostomy had to be performed prior to cholecystectomy. 10 patients recovered without complication, one 89-year old multi-morbid male died after cholecystectomy. Analysis of the clinical course prior to the occurrence of acute cholecystitis showed a high incidence of shock, frequent blood transfusion, long-time respiratory therapy and parenteral nutrition as well severe trauma, and high cumulation of opiate therapy in this group of patients. Diagnosis was confirmed by ultrasound in all patients, clinical symptoms and laboratory data being mostly unspecific.

Predicting quality of deceased donor kidneys: the harvesting surgeon as a prognostic factor?

INTRODUCTION: The quality of donor organs is a crucial factor with regard to graft survival and function in kidney transplant recipients. The prognostic importance of surgeon-related factors during organ harvesting on graft quality has been almost unknown. Our aim was to find out whether surgical expertise as reflected by the time required for kidney retrieval influences graft survival. METHODS: In this retrospective study, we analyzed the records of 200 patients who received a cadaveric renal graft at our institution between 2000 and 2005. Graft survival and function were examined at discharge and after 1, 2, 3, and 5 years post-transplantation with the estimated glomerular filtration rate (GFR) using the Cockroft-Gault formula as a surrogate marker. We gathered the pertinent data on harvesting procedures from Eurotransplant donor reports. We correlated the length of time from cold organ perfusion to nephrectomy with graft survival. Statistical evaluation was performed using correlation analysis. RESULTS: There was no statistically significant correlation between the time the surgeon needed for kidney retrieval (starting from cold perfusion) and the outcome of transplantation. CONCLUSION: It would seem to be obvious that the longer a cadaveric donor kidney remains in the donor's body after cold perfusion, the worse the outcome will be. Our findings, however, did not prove this hypothesis even when looking at abdominal and combined abdominal and thoracic harvesting procedures separately.