Use of Hem-o-lok clips effectively lengthens renal vein during laparoscopic live donor nephrectomy.

We retrospectively reviewed our last 12 laparoscopic donor nephrectomies (LDNs) in which both the renal artery and the renal vein were controlled using 2 Hem-o-lok clips (Weck Closure Systems, Research Triangle Park, NC, United States) on the proximal sides and the vessels were divided without securing the graft-side vessels (group 1). We compared the results with our 12 immediately preceding LDN donors in whom the arteries were controlled with 3 endoclips and the veins were controlled with staplers (group 2). The length of the vein was significantly longer (approximately 4 mm difference) in group 1, mainly due to trimmed staples from the graft vessels. Both cohorts of donors had uneventful surgery with no complications, and all the recipients recovered smoothly without any delayed graft function. Average operation time and warm ischemia time were similar among both groups (189 vs 207 minutes; 168 vs 149 seconds, respectively; both P > .1). We conclude that the use of Hem-o-lok effectively lengthens graft renal veins and is less costly during LDN.

Solitary port-site metastasis after laparoscopic bilateral nephroureterctomy for transitional cell carcinoma in a renal transplant recipient.

A renal transplant recipient with upper tract transitional cell carcinoma developed a solitary port-tract recurrence 8 months after a hand-assisted laparoscopic bilateral nephroureterectomy and was successfully managed by a local wide excision and adjuvant radiotherapy. Follow-up for 3 years after the salvage therapy showed no evidence of local recurrence or distant metastasis. This patient is the first one in the literature to have a solitary port-site metastasis of transitional cell carcinoma in renal transplant recipients.

Pharmacokinetic variability of sirolimus in Taiwanese renal transplant recipients.

To evaluate the pharmacokinetic variability of sirolimus (Rapamycin, SRL) in our renal transplant (RTx) recipients, dose-normalized trough concentration (C(0)) of SRL, and their intrasubject coefficients of variation (%CV) were analyzed. Thirty-eight patients were enrolled in regimens containing SRL. Concomitant immunosuppression included steroids (n = 38), cyclosporine (n = 33), tacrolimus (n = 3), and mycophenolate mofetil (n = 7). The mean dose-normalized C(0) was 2.13 +/- 0.91 ng/mL/mg. The intrasubject %CV of the dose-normalized C(0) ranged from 14% to 88% and averaged 42% in our series. The mean dose-normalized C(0) of SRL in our RTx recipients was much lower than that reported in Phase III trials. The intrasubject variation of dose-normalized C(0), even after administrating SRL for 6 months, could still be quite prominent. Thus, we suggest that, to maintain adequate therapeutic concentrations, periodic (monthly or bimonthly) SRL C(0) measurement is necessary in Taiwanese (Oriental) patients receiving SRL.

Transitional cell carcinoma in renal transplant recipients.

We describe our experience in managing transitional cell carcinoma (TCC) in renal transplant (RTx) recipients. Nineteen RTx recipients (7 men; 12 women) presented with hematuria or hydronephrosis of native kidneys and were suspected with TCC were reviewed retrospectively; 17 of them proved to have TCC. The mean interval of the occurrence of TCC was 58.7 months (range, 3-144 months) after RTx. The patients with suspected upper tract lesions received bilateral nephroureterectomies (BNU) and bladder cuff resection. Transurethral resection of the bladder tumor (TUR-BT) was performed in patients with concomitant or solitary superficial bladder lesions. Of the 15 patients with upper tract TCC, 8 had bilateral lesions pathologically, but only 2 of them were suspected preoperatively on image study. With a mean follow-up of 28 months (range, 1-57 months) both the overall graft and patient survival rates were 76%; 4 patients with advanced diseases at presentation died. Bladder recurrence was noted in 6 patients (35%). Transplant patients with hematuria warrant detailed study of the whole urinary system and periodic ultrasonography of the native kidneys is recommended in all RTx recipients. Simultaneous BNU for the native kidneys is mandatory if there is any evidence of TCC in either renal/ureteral unit.

The utility of resistance index of distal interlobular arteries in evaluating renal graft function.

The correlations of the mean values of resistance index (RI) of the distal interlobular, arcuate, and interlobal arteries of the kidneys were evaluated with HDI 5000 ultrasonographic system using a 2- to 5-mHz scan probe under the power Doppler detection mode in 60 patients with various native renal conditions and 70 renal allografts. The mean values of RIs of the distal interlobular arteries and those of the interlobal arteries in the renal allografts were significantly correlated with the recipients' renal functions (P = .015 and .030, respectively), whereas those of arcuate arteries were not.

Curcumin enhances the immunosuppressive activity of cyclosporine in rat cardiac allografts and in mixed lymphocyte reactions.

Curcumin (CCM; diferuoylmethane) is a dietary pigment in curry with known antineoplastic and anti-inflammatory effects. The immunosuppressive effects of CCM were studied in (1) rat heterotopic cardiac transplant models, using Brown-Norway (BN, RT1(n)) hearts to WKY (RT1(u)) hosts or Buffalo (BUF, RT1(b)) hearts to Wistar-Furth (WF, RT1(u)) hosts, (2) reverse transcriptase-polymerase chain reaction analysis of cytokines from transplanted specimens, and (3) mixed lymphocyte reactions (MLR). In the BN-to-WKY model, CCM alone significantly increased the mean survival time (MST) to 20.5 to 24.5 days, as compared to 9.1 days among nontreated controls. The combination of CCM and subtherapeutic doses of CsA produced further prolongation of the MST to 28.5 to 35.6 days, better than that of CCM or CsA alone (P <.05). In a BUF-to-WF model, CCM alone did not increased the MST, unless it was combined with subtherapeutic doses of CsA, wherein two thirds of the grafts survived for more than 60 days (P <.05 as compared to either treatment group). Cytokine analysis revealed significantly reduced expression of interleukin-2 (IL-2), interferon-gamma (IFN-gamma) and granzyme B in the day 3 specimens of the CCM and CCM CsA-treated allografts compared with the nontreated allograft controls. MLRs using the two MHC-incompatible rat strains (BNxWKY) showed an effect of increasing concentrations of CCM and/or CsA, which by combination index (CI) analysis showed a synergistic effect (CI = 0.22 to 0.81). This study for the first time demonstrates the effectiveness of CCM as a novel adjuvant immunosuppressant with cyclosporine both in vivo and in vitro.